Med Bull Sisli Etfal Hosp. 2019; 53(3): 215-220 | DOI: 10.14744/SEMB.2019.59455

Postprandial Reactive Hypoglycemia

Yüksel Altuntaþ
Department of Endocrinology and Metabolism, University of Health Sciences Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul,Turkey

Reactive hypoglycemia (RH) is the condition of postprandially hypoglycemia occurring 2-5 hours after food intake. RH is clinically seen in three different forms as follows: idiopathic RH (at 180 min), alimentary (within 120 min), and late RH (at 240–300 min). When the first-phase insulin response decreases, firstly, blood glucose starts to rise after the meal. This leads to late but excessive secretion of the second-phase insulin secretion. Thus, late reactive hypoglycemia occurs. Elevated insulin levels also cause down-regulation of the insulin post-receptor on the muscle and fat cells, thus decreasing insulin sensitivity. The cause of the increase in insulin sensitivity in IRH at 3 h is not completely clear. However, there is a decrease in insulin sensitivity in late reactive hypoglycaemia at 4 or 5 hours. Thus, patients with hypoglycemia at 4 or 5 h who have a family history of diabetes and obesity may be more susceptible to diabetes than patients with hypoglycemia at 3 h. We believe that some cases with normal glucose tolerance in OGTT should be considered as prediabetes at <55 or 60 mg/dl after 4-5 hours after OGTT. Metformin and AGI therapy may be recommended if there is late RH with IFG. Also Metformin, AGÝ, TZD, DPP-IVInhibitors, GLP1RA therapy may be recommended if there is late RH with IGT. As a result, postprandial RH (<55 or 60 mg/dl ), especially after 4 hours may predict diabetes. Therefore, people with RH along with weight gain and with diabetes history in the family will benefit from a lifestyle modification as well as the appropriate antidiabetic approach in the prevention of diabetes.

Keywords: AGÝ, DPP-IVInhibitors; metformin; microbiota; postprandially hypoglycemia; prediabetes; reactive hypoglycaemia; TZD.

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Postprandiyal Reaktif Hipoglisemi

Yüksel Altuntaþ
Department of Endocrinology and Metabolism, University of Health Sciences Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul,Turkey

Postprandiyal reaktif hipoglisemi gýda alýmýndan 2-5 saat sonra oluþan hipoglisemi durumudur.ilk 2 saat içinde olursa alimenter, 3.saatte oluþur ise idiopatik, 4. saatten sonra oluþur ise geç reaktif hipoglisemi olarak adlandýrýlýr. OGTT normal olup 4.satten sonra glisemisi 55 veya 60 mg/dl olan kimseler geç reaktif hipoglisemi olarak deðerlendirilmeli ve eðer birinci dereceden yakýnlarýnda diyabet yüklülüðü var ve de kilo artýþý eþlik ediyorsa bu tip hipogliseminin tip 2 diyabeti kuvvetli þekilde predikte edebileceðini düþünmekteyiz. Bu yüzden geç reaktif hipoglisemiyi tanýsýný koymak ve de böylelikle muhtemel bir diyabetin prevansiyonunu da erkenden yapabilmek için için bu özelliliði olan kimselerden istenecek OGTT'in en az 4 saatlik olmasýna dikkat edilmelidir.Bu þekilde yaþam tarzý deðiþikliði yanýnda tip 2 diyabetin prevansiyonu açýsýndan geç reaktif hipoglisemisi olup bozulmuþ açlýk glikozu (IFG) olanlarda metformin, AGÝ, yine geç reaktif hipoglisemisi olup bozulmuþ glukoz toleransý (IGT) olanlarda da metformin, AGÝ, TZD, DPP-IVInhibitors, GLP1RA tedavilerinin gerektiðinde diyabet prevansiyonunda yeni alternatif bir tedavi yaklaþýmý olabileceðini düþünmekteyiz.

Anahtar Kelimeler: Reaktif hipoglisemi, postprandiyal hipoglisemi, metformin, AGÝ, TZD, DPP-IVInhibitors, mikrobiyota

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