[A Case of Reactive Hypoglycemia Exacerbated Before Menstruation Improved by the Use of Continuous Glucose Monitoring].

A 40-year-old female patient was referred to our department with a complaint of postprandial hypoglycemia. We performed a 75g oral glucose tolerance test, and the patient was diagnosed as having impaired glucose tolerance with a 1-hour blood glucose of 245 mg/dl and a 2-hour blood glucose of 196 mg/dl. The patient also showed hypoglycemia with a 6-hour blood glucose of 46 mg/dl, and delayed hypersecretion of insulin, which was diagnosed as reactive hypoglycemia. The patient was diagnosed as having reactive hypoglycemia with delayed hypersecretion of insulin. She was given dietary guidance to avoid simple carbohydrates, and voglibose 0.6 mg was started for glucose intolerance and reactive hypoglycemia. The frequency of hypoglycemic symptoms decreased for a while, but gradually increased again. An interview revealed that the frequency of hypoglycemia was high at 2-3 days before menstruation, and Flash Glucose Monitoring (FGM) was applied to check the blood glucose fluctuation before and after menstruation. Her postprandial hyperglycemia worsened with FGM, and reactive hypoglycemia appeared 3 days before menstruation, while postprandial hyperglycemia improved and reactive hypoglycemia disappeared 4 days after menstruation. The frequency of hypoglycemia was reduced by instructing the patient to take voglibose before menses and to eat a supplementary meal after lunch a few days before menses. There have been no reports on the evaluation of reactive hypoglycemia exacerbated before menstruation by FGM. The menstrual cycle should be considered in the diagnosis, evaluation, and treatment of reactive hypoglycemia.

The gastro-jejunal anastomosis site influences dumping syndrome and weight regain in patients with obesity undergoing Laparoscopic Roux-en-Y Gastric Bypass.

PURPOSE: The Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is an effective weight loss procedure. The gastro-jejunal (GJ) anastomosis required can be performed on the anterior or posterior gastric pouch wall. No studies have compared these variants in terms of efficacy and onset of dumping syndrome (DS) and weight regain (WR). We aimed at assessing the prevalence of DS in relation to the site of anastomosis together with identifying prognostic factors of DS and WR. METHODS: Patients who had undergone LRYGB with anterior (AGJ) or posterior (PGJ) anastomosis in 2010-2019 were retrospectively analyzed. We collected demographic data, medical history and the prevalence of DS evaluated through the Sigstad Score, together with WR data. RESULTS: 213 patients were enrolled, of which 51.6% had an AGJ and 48.4% had a PGJ. The mean follow-up time was 81 ± 18 and 27 ± 13 months in the AGJ and PGJ group, respectively (p < 0.0001). Excess weight loss was 77.59% and 94.13% in patients with AGJ and PGJ, respectively (p < 0.001). WR rate was 16% and 4% in the AGJ and PGJ population, respectively (p < 0.001). DS prevalence was 38% and 76% in the AGJ and the PGJ population, respectively (p < 0.0001). The site of anastomosis was identified as an independent predictor of DS (OR5.15; 95% CI 2.82-9.41; p < 0.0001) and WR (OR5.31; 95% CI 2.32-12.15; p < 0.0001). Obesity-related complications significantly improved after surgery independent of the anastomosis site. CONCLUSION: LRYGB is effective in determining long-term weight loss and improvement of complications. AGJ is associated with lower prevalence of DS but more frequent WR. The anastomosis site is a factor to be considered when performing LRYGB. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

[Reactive hypoglycemia - an interdisciplinary approach of the disease of XXI Century].

Reactive hypoglycemia is characterized by low blood glucose level in non-diabetic patients. It manifests as a syndrome of adrenergic and neuroglycopenic symptoms in the postprandial period, and their resolution occurs after consuming carbohydrates. The etiology of reactive hypoglycemia is not fully understood. It may occur in patients after gastrointestinal surgery due to too fast gastric emptying. Decreases in postprandial glucose are also observed in people with a pre-diabetes condition in which insulin secretion is disturbed. Hypoglycaemia can also be seen in patients with insulin resistance and hyperinsulinism. The aim of this study was to summarize existing knowledge about reactive hypoglycemia - etiology, diagnostic model and treatment.

Does reactive hypoglycemia during the 100 g oral glucose tolerance test adversely affect perinatal outcomes?

OBJECTIVES: To determine whether pregnant women who have reactive hypoglycemia during the 100 g oral glucose toler-ance test (OGTT) are at an increased risk of poor pregnancy outcomes. MATERIAL AND METHODS: We retrospectively analyzed perinatal data from 413 women who underwent a 3 h OGTT at 24-28 weeks of gestation and gave birth in our clinics between January 2012 and December 2014. RESULTS: According to OGTT results, the majority of the subjects were normoglycemic (n = 316, 76.5%), while 49 (11.9%) were diagnosed with gestational diabetes, and 33 (8.0%) had single high glucose values. Reactive hypoglycemia was de-tected in only 15 patients (3.6%). The mean age of the women in the reactive hypoglycemia group was significantly lower than that of the women in the gestational diabetes and single high glucose value groups (26.4 ± 4.4 years, 31.4 ± 5.4 years, and 31.8 ± 4.3 years, respectively; p < 0.05). The newborns of the women in the reactive hypoglycemia group had higher rates of APGAR scores < 7, increased admission to the neonatal intensive care unit (NICU), and lower birth weights compared with the other groups (p < 0.001, p < 0.001, and p = 0.009, respectively). CONCLUSION: Reactive hypoglycemia during the 3 h 100 g OGTT is significantly associated with low APGAR scores, low birth weights, and prenatal admission to the NICU. Therefore, pregnant women who develop hypoglycemia during the 100 g OGTT performed at 24-28 weeks of gestation should receive attentive follow-up care to decrease the possibility of adverse perinatal outcomes.

Gut microbiome response to short-term dietary interventions in reactive hypoglycemia subjects.

BACKGROUND: Reactive hypoglycemia is a metabolic disorder that provokes severe hypoglycemic episodes after meals. Over recent years, the gut microbiota has been recognized as potential target for the control of metabolic diseases, and the possibility to correct gut microbiota dysbioses through diet, favouring the recovery of metabolic homeostasis, has been considered. METHODS: We investigate the impact of 2 short-term (3-day) nutritional interventions, based on the macrobiotic Ma-Pi 2 diet and a control Mediterranean diet, on the structure and functionality of the gut microbiota in 12 patients affected by reactive hypoglycemia. The gut microbiota composition was characterized by next-generation sequencing of the V3 to V4 region of the 16S rRNA gene, and the ecosystem functionality was addressed by measuring the faecal concentration of short-chain fatty acids (SCFAs). In order to measure the short-term physiological gut microbiota fluctuation, the microbiomes of 7 healthy people were characterized before and after 3 days of constant diet. RESULTS: While no convergence of the gut microbiota compositional profiles was observed, a significant increase in SCFA faecal levels was induced only in the Ma-Pi 2 diet group, suggesting the potential of this diet to support a short-term functional convergence of the gut microbiota, regardless of the individual compositional layout. CONCLUSIONS: The Ma-Pi 2 diet, with its high fibre load, was effective in increasing the production of SCFAs by the gut microbiota. Because these metabolites are known for their ability to counterbalance the metabolic deregulation in persons with glucose impairment disorders, their increased bioavailability could be of some relevance in reactive hypoglycemia.

Sitaglitpin phosphate treatment in patients with reactive hypoglycemia secondary to dysinsulinism. Controlled, randomized, double-blind study. / Tratamiento con fosfato de sitagliptina en pacientes con hipoglucemia reactiva secundaria a disinsulinismo. Estudio controlado, aleatorizado y doble ciego.

Objective: We evaluated the effect of sitagliptin in correction of symptomatic reactive hypoglycemia. Methods: Randomized, double blind, placebo-controlled clinical trial. Thirteen patients treated with sitagliptin and 15 with placebo, with mean age of 34.3 ± 10.6 years and body mass index of 24.6 ± 5.1 kg/m2, mostly women (n = 24, 85.7%), were evaluated. Results: Basal glycemia was similar in placebo versus sitagliptin (92.3 ± 18.9 vs. 93.4 ± 17.3 mg/dl; p = 0.41) as was median and interquartile range of insulin (15.2 [8.8-43.7] vs. 14.7 µU/ml [7.0-39.0]; p = 0.44). Patients with sitagliptin recovered the first phase insulin secretion (FISP). This was related with higher glucose level at the end of the oral glucose tolerance test (79.5 [74.2-83.0] vs. 83.5 [81.2-89.7]; p = 0.003) with a similar insulin median level (13.0 [5.0-34.4] vs. 13.8 [4.8-30.6]; p = 0.32). Symptomatology was significantly lower under sitagliptin treatment (p < 0.0001). Conclusions: Sitagliptin improved FISP and reduced post-prandial symptomatology. These results suggest a novel therapeutic option for patients with reactive hypoglycemia related with FISP.

Prevalence and possible mechanisms of reactive hypoglycemia in polycystic ovary syndrome.

STUDY QUESTION: What is the prevalence of reactive hypoglycemia (RH) in polycystic ovary syndrome (PCOS) versus age- and body mass index (BMI)-matched healthy controls. SUMMARY ANSWER: The prevalence of RH was increased in PCOS versus controls. WHAT IS KNOWN ALREADY: Previous studies suggested an increased prevalence of RH in PCOS. STUDY DESIGN, SIZE, DURATION: Cross-sectional study of 88 women with PCOS and 34 healthy age- and BMI-matched controls. PARTICIPANTS/MATERIALS, SETTING, METHODS: Eighty-eight women with PCOS and 34 age- and BMI-matched controls were included. The study was conducted at Odense University Hospital, Denmark. Participants underwent 5 h oral glucose tolerance test (5 h OGTT). Indices of insulin resistance, ß-cell function, and area under the curve (AUC) for glucose, insulin and C-peptide were calculated. Insulin clearance was estimated as 5 h AUC C-peptide/insulin. RH was defined as blood glucose ≤3.3 mmol/l during 5 h OGTT. MAIN RESULTS AND THE ROLE OF CHANCE: RH occurred in 15/88 (17%) women with PCOS versus 0/34 controls ( ITALIC! P = 0.01). Nine out of 15 women with RH were obese and 6 were lean ( ITALIC! P = 0.42). Obese patients with RH had significantly higher 5 h AUCs insulin and C-peptide compared with lean patients with RH ( ITALIC! P = 0.02 and 0.04, respectively). Obese patients with RH had significantly lower 5 h AUC C-peptide/insulin versus obese patients without RH ( ITALIC! P = 0.02). In lean patients with RH, 5 h AUCs insulin and C-peptide were similar to lean controls. LIMITATIONS, REASONS FOR CAUTION: The 5 h OGTT was used to diagnose RH and may be a limitation of the study. Although the 5 h OGTT is the most widely accepted method, no gold standard exists in terms of diagnosing RH. The 5 h OGTT was suggested to over-estimate the incidence of RH compared with meal test. WIDER IMPLICATIONS OF THE FINDINGS: The study supports previous suggestions of increased prevalence of RH in women with PCOS compared with controls. STUDY FUNDING/COMPETING INTERESTS: This study was funded by Jacob Madsen's and Olga Madsen's Foundation, Institute of Clinical Research, Odense University Hospital, Kolding Hospital, AP Møller's Foundation, Bernhard and Marie Kleins Foundation, The Novo Nordisk Foundation, and The Danish Medical Association. The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER: The trial was registered at www.clinicaltrials.gov (registration numbers NCT00451568 (patients) and NCT01995773 (controls)).

Assessing the impact of body composition, metabolic and oxidative stress parameters on insulin resistance as a prognostic marker for reactive hypoglycemia: a cross-sectional study in overweight, obese, and normal weight individuals.

Oxidative stress (OS) plays a pivotal role in the pathogenesis of insulin resistance (IR), particularly in its association with obesity. This study evaluate both the diagnostic and clinical significance of assessing oxidative status in patients affected by overweight and obesity displaying IR, especially with reactive hypoglycemic episodes (RH). A comprehensive examination of OS biomarkers was carried out, encompassing measurements of total oxidative capacity (TOC) and total antioxidant capacity (TAC). Our analysis results reveal noteworthy connections between OS levels and the severity of IR in overweight and obese patients. Moreover, in the study, we demonstrated the diagnostic utility of serum concentrations of TAC and TOC as indicators of the risk of RH, the occurrence of which, even at the stage of overweight, may be associated with increased OS and further development of obesity. Our findings imply that the evaluation of oxidative status could serve as a crucial diagnostic and prognostic tool for patients observed with IR and overweight and obesity. In conclusion, our study underscores the potential utility of assessing oxidative status in the context of IR and highlights the possibility of identifying novel therapeutic targets for the treatment of overweight and obese patients.

Reactive Hypoglycemia in Patients Prior to Cataract Surgery: A Case Series.

Cataract surgery is one of the most frequently performed surgical procedures and is often performed under topical anesthesia in conscious patients. Sweating, palpitations, and anxiety may be seen in patients about to undergo surgery. However, these are typical adrenergic symptoms of hypoglycemia and should be further investigated if occurring before surgery. Here, we report five cases of postprandial or reactive hypoglycemia observed in hospital settings just before conducting cataract surgeries in non-diabetic 52-78-year-old patients from 2019 to 2023.

A Case of End-stage Renal Disease in Which Diazoxide was Effective in Treating Hypoglycemia Caused by Late Dumping Syndrome after Gastrectomy.

We herein report a case in which diazoxide was effective in treating reactive hypoglycemia caused by late dumping syndrome in a patient with ESRD. A 50-year-old man with end-stage renal disease (ESRD) and a history of gastrectomy underwent hemodialysis. Although he was administered voglibose to treat recurrent reactive hypoglycemia caused by late dumping syndrome, he had difficulty continuing treatment because of gastrointestinal side effects. When he began diazoxide treatment, the reactive hypoglycemia improved. The dose was gradually increased with no apparent side effects, and the hypoglycemic attacks disappeared one year after the start of treatment.

Lower Glucose Effectiveness Is Associated with Subclinical Reactive Hypoglycemia, Snacking Habits, and Obesity.

The effects of glucose effectiveness, the insulin-independent mechanism of glucose disposal, on hypoglycemia have not yet been fully investigated. Herein, in 50 males without a diagnosis of diabetes mellitus (median age 54 years, body mass index (BMI) ≥ 25), the index of glucose effectiveness (SgIo) was determined by a 75 g oral glucose tolerance test (OGTT), and continuous glucose monitoring (CGM) was performed for 6 days. The minimal glucose levels and the percentages of time below 70 mg/dL (3.9 mmol/L) (TBR70) during CGM were significantly associated with the SgIo tertile category in a biphasic manner. When TBR70 within 24 h after OGTT ≥ 0.6% was defined as subclinical reactive hypoglycemia (SRH), odds ratios of having SRH in SgIo tertile 1 (lowest) and tertile 3 (highest) compared to SgIo tertile 2 (middle) were both 11.7 (p = 0.007), while the odds ratios of the highest post-load insulin quartile were 22.9 (p = 0.001) and 1.07 (p = 0.742), respectively. The chances of having self-reported snacking habits, obesity (BMI ≥ 30), and impaired glucose tolerance were significantly higher in participants in SgIo tertile 1 compared to those in SgIo tertile 2, with odds ratios of 10.7 (p = 0.005), 11.2 (p = 0.02), and 13.8 (p = 0.002), respectively. However, there was no significant difference between SgIo tertile categories 2 and 3. In conclusion, SgIo is associated with SRH in a biphasic manner. In people with lower glucose effectiveness, the SRH-induced increase in appetite may create a vicious cycle that leads to obesity.

Reactive hypoglycemia owing to an intrahepatic congenital portosystemic shunt in an older patient.

An 85-year-old woman was admitted to our hospital because of hypoglycemia and impairment of consciousness several hours after breakfast. Because the hypoglycemia predominantly occurred 2-4 h after meals, we diagnosed reactive hypoglycemia. An oral glucose tolerance test showed prolonged hyperinsulinemia following the postprandial hyperglycemia, with a subsequent rapid decrease in blood glucose concentration. The post-stimulus plasma C-peptide concentration was relatively low compared to the plasma insulin concentration. Abdominal computed tomography revealed an intrahepatic congenital portosystemic shunt (CPSS). On the basis of these findings, we concluded that the reactive hypoglycemia was induced by the CPSS, via a reduction in hepatic insulin extraction. Treatment with an alpha-glucosidase inhibitor resolved the reactive hypoglycemia. CPSS comprises anomalous vascular connections between the portal vein and the systemic venous circulation, and reactive hypoglycemia is a rare complication of this malformation, which has most frequently been reported in children, with only a few cases reported in adults. However, this case indicates that even in adult patients, imaging studies should be conducted to rule out CPSS as the cause of the reactive hyperglycemia.

Subclinical Reactive Hypoglycemia with Low Glucose Effectiveness-Why We Cannot Stop Snacking despite Gaining Weight.

Obesity has grown worldwide owing to modern obesogenic lifestyles, including frequent snacking. Recently, we studied continuous glucose monitoring in obese/overweight men without diabetes and found that half of them exhibit glucose levels less than 70 mg/dL after a 75-g oral glucose load without notable hypoglycemic symptoms. Interestingly, people with "subclinical reactive hypoglycemia (SRH)" snack more frequently than those without it. Since the ingestion of sugary snacks or drinks could further induce SRH, a vicious cycle of "Snacking begets snacking via SRH" can be formed. Glucose effectiveness (Sg) is an insulin-independent mechanism that contributes to most of the whole-body glucose disposal after an oral glucose load in people without diabetes. Our recent data suggest that both higher and lower Sg are associated with SRH, while the latter but not the former is linked to snacking habits, obesity, and dysglycemia. The present review addresses the possible role of SRH in snacking habits in people with obesity/overweight, taking Sg into account. It is concluded that, for those with low Sg, SRH can be regarded as a link between snacking and obesity. Prevention of SRH by raising Sg might be key to controlling snacking habits and body weight.

Postprandial hypoglycemia after ileocolic interposition and Billroth-II gastrojejunostomy: A case report.

Postprandial reactive hypoglycemia, or late dumping syndrome, is a common but underrecognized complication from bypass surgery. We report an unusual case of postprandial reactive hypoglycemia in a patient with a severe esophageal stricture from corrosive agent ingestion who underwent ileocolic interposition and an antecolic Billroth-II gastrojejunostomy. A 22-year-old male patient with a one-year history of corrosive ingestion was referred to the hospital for a surgical correction of severe esophageal stricture. After the patient underwent ileocolic interposition and an antecolic Billroth-II gastrojejunostomy, he experienced multiple episodes of gastroesophageal refluxsymptoms during nasogastric feeding and had onset of hypoglycemic symptoms. His plasma glucose level was 59 mg/dL. After we had intraoperatively re-inserted a jejunostomy tube bypassing the ileocolic interposition, and reintroduced enteral nutrition, his hypoglycemic symptoms resolved. We performed a mixed meal tolerance test by nasogastric tube, but the results did not show postprandial hypoglycemia. Although the specific mechanism is unclear, this case suggests gastroesophageal reflux to the ileal interposition may have caused a state of exaggerated hyperinsulinemic response and rebound hypoglycemia. To the best of our knowledge, we are the first to report case of postprandial hypoglycemia after ileocolic interposition, which may have been caused by exaggerated hyperinsulinemic response due to gastroesophageal reflux to the ileal interposition. This syndrome should be considered in the patient who has had ileocolic interposition surgery and has developed postprandial hypoglycemia.

Reactive Hypoglycemia: A Trigger for Nutrient-Induced Endocrine and Metabolic Responses in Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is an insulin-resistant state compensated for by the body via hyperinsulinemia. More than 50% of women with PCOS are obese and/or have metabolic syndrome. Weight loss improves both metabolic and reproductive outcomes. Energy/caloric content as well as the nutrient composition of one's diet may also be important. This article will present a series of studies from our research comparing the effects of dietary protein vs. simple carbohydrates (CHOs). The results of the acute challenge studies demonstrate that simple CHO intake causes reactive hypoglycemia in one third of women with PCOS, especially among obese and insulin-resistant individuals. Symptoms of hypoglycemia are associated with secretion of cortisol and adrenal androgens. Simple CHOs suppress the hunger signal ghrelin for a shorter period. During weight loss, women who receive protein supplementation achieve more significant weight and fat mass losses. The amino acid compositions of the protein supplements do not affect the improvements in weight and insulin resistance. It is plausible that simple CHO intake leads to weight gain, or interferes with weight loss, by causing reactive hypoglycemia, triggering adrenal steroid secretion and thus leading to snacking. Since obese women with PCOS are more susceptible to reactive hypoglycemia, a vicious cycle is established. Restriction of simple CHOs may break this cycle.

Four sidenotes about glucagon peptides.

Century old glucagon is a classic pancreatic hormone. But today we also know that the glucagon gene is expressed at high levels at extrapancreatic sites - particularly so in the gut. Major hormonal glucagon gene products in the digestive tract are the two glucagon-like peptides (GLP-1 and -2). Of these, truncated GLP-1 has in recent decades attracted massive interest due to its incretin effect, and the subsequent GLP-1 derived design of potent diabetes and obesity drugs. Truncated GLP-1 has consequently become an important contributor to gastrointestinal endocrinology. The gastrointestinal branch of endocrinology today includes more than 100 bioactive peptides encoded by some 30 different hormone genes. Therefore, the gut is the largest endocrine organ in the body. In addition to a general discussion of glucagon peptides in the hierarchy of gut hormones, this review also includes three short notes about glucagon studies from the 1970s. These studies dealt with reactive hypoglycemia, chronic liver disease, and the secretory response of pancreatic glucagon to gastrin/cholecystokinin stimulation. Considering today's possibilities in molecular endocrinology, revisits to the questions raised by these studies might be worthwhile.

Assessing Long-Term Impact of Dietary Interventions on Occurrence of Symptoms Consistent with Hypoglycemia in Patients without Diabetes: A One-Year Follow-Up Study.

Background: A well-balanced nutritional diet pattern has a significant role in the management of diet-related disorders. Currently, there are no specific dietary guidelines to refer to when advising non-diabetic patients with symptoms attributed to hypoglycemia in the postprandial period or patients with confirmed reactive hypoglycemia (RH). The aim of this study was to investigate the impact of the dietary interventions, and their sustained outcome, on the severity of hypoglycemic-like symptoms occurring in non-diabetic patients. Methods: The study group included forty non-diabetic individuals with symptoms consistent with RH. At the baseline, each patient underwent RH diagnosis and complex dietary evaluation. Over a period of six months, each patient had four appointments with a dietitian. Two sessions were focused on a dietary education about low glycemic index diet (LGID) and Mediterranean diet (MD). The said diets were to be followed for a period of three months, with two additional dietary check-ups. Once dietary supervision was completed, patients had no imposed dietary patterns. The final follow-up appointment took place twelve months later and that is when each patient underwent a detailed assessment of their current dietary habits and evaluation of the frequency of symptoms consistent with hypoglycemia. Results: There was a statistically significant reduction in the severity in eight out of the ten analyzed hypoglycemic-like symptoms after the dietary interventions. The most significant change was observed in the following symptoms: hunger (η2 = 0.66), impaired concentration (η2 = 0.61), hand tremor (η2 = 0.55), and fatigue (η2 = 0.51). The outcomes were comparable for both recommended diets, the LGID and the MD. The reduction in hypoglycemic-like symptoms continued after the twelve-month period. The individualized dietary counselling significantly improved the patients' eating habits in comparison to those present prior to intervention in terms of healthy diet index (F(2,78) = 27.30, p < 0.001, η2 = 0.41, 90%CI [0.26; 0.51]) and unhealthy diet index (F(2,78) = 433.39, p < 0.001, η2 = 0.91, 90%CI [0.89; 0.93]). Conclusions: Healthy modifications in dietary habits may improve patient's well-being and reduce the severity of their postprandial symptoms attributed to hypoglycemia. Therefore, dietary intervention focused on appropriate nutritional management combined with follow-up consultations may be a beneficial step towards comprehensive treatment of non-diabetic patients who present with hypoglycemic-like symptoms in the postprandial period.

Metabolic Parameters in Patients with Suspected Reactive Hypoglycemia.

BACKGROUND: It remains unclear whether reactive hypoglycemia (RH) is a disorder caused by improper insulin secretion, result of eating habits that are not nutritionally balanced or whether it is a psychosomatic disorder. The aim of this study was to investigate metabolic parameters in patients admitted to the hospital with suspected RH. METHODS: The study group (SG) included non-diabetic individuals with symptoms consistent with RH. The control group (CG) included individuals without hypoglycemic symptoms and any documented medical history of metabolic disorders. In both groups the following investigations were performed: fasting glucose and insulin levels, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), 75 g five-hour Oral Glucose Tolerance Test (OGTT) with an assessment of glucose and insulin and lipid profile evaluation. Additionally, Mixed Meal Tolerance Test (MMTT) was performed in SG. Results from OGTT and MMTT were analyzed in line with the non-standardized RH diagnostic criteria. RESULTS: Forty subjects have been enrolled into SG. Twelve (30%) of those patients had hypoglycemic symptoms and glucose level ≤55 mg/dL during five-hour OGTT and have been diagnosed with RH. Ten (25%) subjects manifested hypoglycemic like symptoms without significant glucose decline. Patients with diagnosed RH had statistically significantly lower mean glucose at first (92.1 ± 37.9 mg/dL vs. 126.4 ± 32.5 mg/dL; LSD test: p < 0.001) and second (65.6 ± 19.3 mg/dL vs. 92.6 ± 19.3 mg/dL; LSD test: p < 0.001) hour of OGTT and insulin value (22.7 ± 10.9 lU/mL vs. 43.4 ± 35.0 lU/mL; LSD test: p < 0.001) at second hour of OGTT compared to the patients who did not meet the criteria of RH. Seventeen (43%) subjects from SG reported symptoms suggesting hypoglycemia during MMTT but none of them had glucose value lower than ≤55 mg/dL (68.7 ± 4.7 mg/dL). From the entire lipid profile, only mean total cholesterol value was significantly higher (p = 0.024) in SG in comparison with CG but did not exceed standard reference range. CONCLUSIONS: No metabolic disturbances have been observed in patients with diagnosed reactive hypoglycemia. Hyperinsulinemia has not been associated with glycemic declines in patients with this condition. Occurrence of pseudohypoglicemic symptoms and lower glucose value was more common after ingestion of glucose itself rather than after ingestion of a balanced meal. This could suggest an important role that nutritionally balanced diet may play in maintaining correct glucose and insulin levels in the postprandial period.

Continuous Glucose Monitoring to Diagnose Hypoglycemia Due to Late Dumping Syndrome in Children After Gastric Surgeries.

Gastrostomy tubes (G-tubes) and Nissen fundoplication are common surgical interventions for feeding difficulties and gastroesophageal reflux disease in children. A potential yet often missed, complication of these procedures is dumping syndrome. We present 3 pediatric patients with postprandial hypoglycemia due to late dumping syndrome after gastric surgeries. All patients received gastrostomy tubes for feeding intolerance: 2 had Nissen fundoplication for gastroesophageal reflux disease, and 1 had tracheoesophageal repair. All patients underwent multiple imaging studies in an to attempt to diagnose dumping syndrome. Continuous glucose monitoring (CGM) was essential for detecting asymptomatic hypoglycemia and glycemic excursions occurring with feeds that would have gone undetected with point-of-care (POC) blood glucose checks. CGM was also used to monitor the effectiveness of treatment strategies and drive treatment plans. These cases highlight the utility of CGM in diagnosing postprandial hypoglycemia due to late dumping syndrome, which is infrequently diagnosed by imaging studies and intermittent POC blood glucose measurements.