hypoglycemia of nondiabetic origin

Question 1

in short, what is hypoglycemia of nondiabetic origin?

Answer 1

a clinical syndrome with diverse causes in which decreases levels of plasma glucose eventually leading to neuroglycopenia

Question 2

when are symptoms felt and what are they?

Answer 2

symptoms are often felt when blood glucose is less thn 3.6 mmol/L

symptoms include:
- sweating
- shakiness
- hunger
- headaches
- irritability

Question 3

what is the main way to diagnose hypoglycemia of nondiabetic origin

Answer 3

measure blood glucose while the individual is experiencing symptoms

Question 4

what are the 3 types of nondiabetic hypoglycemia?

Answer 4

1. postprandial (reactive) hypoglycemia
2. idiopathic reactive hypoglycemia
3. fasting (postabsorptive) hypoglycemia

Question 5

what is postprandial hypoglycemia?

Answer 5

it is reactive.
- when blood glucose falls below normal limits within 2-5 hours after eating

Question 6

what is postprandial hypoglycemia caused by?

Answer 6

• can be caused by exaggerated or late insulin response, caused by either:
  a. insulin resistance or elevated GLP-1
  b. alimentary hyperinsulinism (common after gastric surgery)
  c. renal glycosuria
  d. defects in glucagon response
  e. high insulin sensitivity
  f. rare syndromes such as:
• hereditary fructose intolerance
• glastosemia
• leucine sensitivity
• rare B cell tumor

Question 7

what is idiopathic reactive hypoglycemia?

Answer 7

it is characterized by normal insulin secretion but increases insulin sensitivity and decreases response of glucagon to acute hypoglycemia symptoms
- has been innappropriately diagnosed by physicians and patients to the point that some doubt its existence
- RARE

Question 8

what is fasting (postabsorptive) hypoglycemia?

Answer 8

often related to an underlying disease
- may occur in response to having gone without food for 8 hours or more
- can be caused by conditions that upset the body’s ability to balance blood glucose
(includes eating disorders and other medical conditions including hormone deficiency, acquired liver disease, renal disease, certain drugs, insulinoma, and other nonpancreatic tumors)

Question 9

what are the symptoms of fasting hypoglycemia in a nondiabetic?

Answer 9

loss of mental acuity
seizures
unconsciousness

Question 10

how are episodes of fasting hypoglycemia in a non diabetic eliminated?

Answer 10

resolving the underlying problem typically leads to the elimination of hypoglycemic episodes

Question 11

how is hypoglycemia in a non diabetic diagnosed?

Answer 11

1. blood glucose less than 3.0 mmol/L (clincially significant hypoglycemia)
   (measured at home with the finger prick during spontaneous, symptomatic episodes)
2. may alternately, perform a glucose test in a medical office after the patient has been given a meal/snack that has in past led to symptomatic episodes
   (if symptoms disappear on eating and blood glucose is low during the symptomatic period, then hypoglycemia is likely responsible)

correct diagnosis is important as implications are serious

Question 12

how is hypoglycemia in a non diabetic managed?

Answer 12

1. restoring blood glucose to the normal range to relieve neuroglycopenic symptoms
2. limited of the underlying cause

goal is to adopt eating habits that keep blood glucose as stable as possible
(small, frequent meals (5-6/day) with manageable amounts of CHO)

patient may benefit from learning CHO counting and an eating plan dictating particular CHO intake for each meal and snack