Postprandial hypoglycemic syndrome
Keywords:postprandial syndrome, reactive hypoglycemia, GLP-1, review
AbstractPostprandial hypoglycemic syndrome, or reactive hypoglycemia, — vegetative symptoms, such as weakness, fatigue, hunger, nausea, palpitations, anxiety, tremor, sweating occurring one to two hours after ingestion. The syndrome is poorly described in literature and most of the information is disparate. Laboratory criteria for the diagnosis of postprandial reactive hypoglycemia are quite controversial, but most authors tend to consider that it is a blood glucose level, which is below 3.9 mmol/l for two hours after meal. Hypoglycemia is an unbalance between glucose influx to the circulation (from endogenous glucose production or exogenous glucose delivery) and glucose efflux. The balance between glucose intake and consumption is controlled by a complex balance of glycoregulatory hormones. Insulin, glucagon and adrenaline are effective for several minutes, but cortisol and growth hormone — for seve-ral hours. This explains the presence of immediate and delayed various effects: adrenergic, neuroglycopenic ones and gastroin-testinal discomfort. Postprandial syndrome mechanisms are similar to post-gastric bypass patients with morbid obesity. The most likely cause of reactive hypoglycemia is post-prandial hypersecretion of insulin under the influence of glucose and glucagon-like peptide-1 (GLP-1), which is a component of the enteroendocrine system and acts at the cephalic phase of satiety. Both post-gastric bypass and relatively healthy individuals have symptoms after the meal rich of simple carbohydrates. Symptoms could be effectively reduced by low glycemic index diet rich of dietary fibers. When the effect is insufficient, it is recommended to use acarbose as an α-glucosidase inhibitor, which is the main stimulation of GLP-1 secretion. Thus, obesity epidemics based on the inadequate nutritional habits in the children makes the postprandial syndrome feasible, and it requires further studies. At the same time, healthy diet can significantly improve the quality of life of children with postprandial discomfort.
Hanefeld M1, Temelkova-Kurktschiev T. Control of post-prandial hyperglycemia-an essential part of good diabetes treatment and prevention of cardiovascular complications. Nutr Metab Cardiovasc Dis. 2002 Apr;12(2):98-107. PMID: 12189909.
Raz I, Ceriello A, Wilson PW, Battioui C, Su EW, Kerr L, Jones CA, Milicevic Z, Jacober SJ. Post Hoc Subgroup Analysis of the HEART2D Trial Demonstrates Lower Cardiovascular Risk in Older Patients Targeting Postprandial Versus Fasting/Premeal Glycemia. Diabetes Care. Jul 2011;34(7):1511-13. doi: 10.2337/dc10-2375.
Leonetti F, Morviducci L, Giaccari A, Sbraccia P, Caiola S, Zorretta D, Lostia O, Tamburrano G. Idiopathic reactive hypoglycemia: a role for glucagon? J Endocrinol Invest. 1992;15(4):273-8. doi:10.1007/BF03348727.
Adeva-Andany MM, González-Lucán M, Donapetry-García C, Fernández-Fernández C, Ameneiros-Rodríguez E. Glycogen metabolism in humans. BBA Clinical. 2016;5:85-100. PMID: 27051594. doi: 10.1016/j.bbacli.2016.02.001.
Sivakumar Th, Sivakumar S, Chaychi L, Comi RJ. A Review of the Use of Acarbose for the Treatment of Post-prandial Syndrome (Reactive Hypoglycemia). Endocrinol Metabol Syndrome 2012;S1. doi: 10.4172/2161-1017.S1-010.
Middleton SJ, Balan K. Post-prandial reactive hypoglycaemia and diarrhea caused by idiopathic accelerated gastric emptying: a case report. Journal of Medical Case Reports. 2011;5:177. doi: 10.1186/1752-1947-5-177.
Middleton SJ, Balan K. Idiopathic accelerated gastric emptying presenting in adults with post-prandial diarrhea and reactive hypoglycemia: a case series. Journal of Medical Case Reports. 2012;6:132. doi:10.1186/1752-1947-6-132.
Pannacciulli N, Le DS, Salbe AD, Chen K, Reiman EM, Tataranni PA, Krakoff J. Postprandial glucagon-like peptide-1 (GLP-1) response is positively associated with changes in neuronal activity of brain areas implicated in satiety and food intake regulation in humans. Neuroimage 2007;35(2):511-7. doi: 10.1016/j.neuroimage.2006.12.035.
Posovszky C, Wabitsch M. Regulation of appetite, satiation and body weight by enteroendocrine cells. Part 1: characteristics of enteroendocrine cells and their capability of weight regulation. Horm Res Paediatr. 2015;83(1):1-10. PMID: 25471008. doi: 10.1159/000368898.
Chaychenko T, Georgievskaya N. Metabolic and psychological restricts of nutrition correction in overweight children. Zdorov'e rebenka. 2016; 5.1(73.1):7-12. doi: 10.22141/2224-0522.214.171.124.1.2016.78934. (In Russian).
Salehi M, Gastaldelli A, D’Alessio DA. Blockade of glucagon-like peptide 1 receptor corrects postprandial hypoglycemia after gastric bypass. Gastroenterology. 2014 Mar;146(3):669-80. PMID: 24315990. doi: 10.1053/j.gastro.2013.11.044.
Valderas JP, Ahuad J, Rubio L, Escalona M, Pollak F, Maiz A. Acarbose improves hypoglycaemia following gastric bypass surgery without increasing glucagon-like peptide 1 levels. Obes Surg. 2012 Apr;22(4):582-6. doi: 10.1007/s11695-011-0581-0.
Goldfine AB, Mun EC, Devine E, et al. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. J Clin Endocrinol Metab. 2007;92(12):4678-85. PMID: 17895322. doi: 10.1210/jc.2007-0918.
Salehi M, Prigeon RL, D’Alessio DA. Gastric bypass surgery enhances glucagon-like Peptide 1-stimulated postprandial insulin secretion in humans. Diabetes. 2011;60(9):2308-14. PMID: 21868791. doi: 10.2337/db11-0203.
Jorgensen NB, Dirksen C, Bojsen-Moller KN, et al. Exaggerated glucagon-like peptide 1 response is important for improved beta-cell function and glucose tolerance after Roux-en-Y gastric bypass in patients with type 2 diabetes. Diabetes. 2013;62(9):3044-52. PMID: 23649520. doi: 10.2337/db13-0022.
Dungan KM, Weitgasser R, Perez Manghi F, et al. A 24‐week study to evaluate the efficacy and safety of once‐weekly dulaglutide added on to glimepiride in type 2 diabetes (AWARD‐8). Diabetes, Obesity & Metabolism. 2016;18(5):475-82. doi: 10.1111/dom.12634.
Craig CM, Liu LF, Deacon CF, Holst JJ, McLaughlin TL. Critical role for GLP-1 in symptomatic post-bariatric hypoglycaemia. Diabetologia. 2017 Mar;60(3):531-540. doi: 10.1007/s00125-016-4179-x. Epub 2016 Dec 14.
De Graaf C, Donnelly D, Wootten D, et al. Glucagon-Like Peptide-1 and Its Class B G Protein–Coupled Receptors: A Long March to Therapeutic Successes.Pharmacological Reviews. 2016;68(4):954-1013. doi: 10.1124/pr.115.011395.
Berlin I, Grimaldi A, Landault C, Cesselin F, Puech AJ. Suspected postprandial hypoglycemia is associated with beta-adrenergic hypersensitivity and emotional distress. J Clin Endocrinol Metab. 1994 Nov;79(5):1428-33. doi: 10.1210/jcem.79.5.7962339.
WHO fact sheet N 311, jan.2015. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/
Interim report of the Commission on Ending Childhood Obesity. World Health Organization 2015. Available from URL: http://www.who.int/end-childhood-obesity/commission-ending-childhood-obesity-interim-report.pdf?ua=1
Chaychenko T, Rybka O, Georgievska N, Buginska N. Trends of nutrition of eastern Ukrainian children: tendency to overweight, dehydration and impaired social adaptation. Horm Res Pediatr. 2016; 86(S1):1-556. doi: 10.1159/000449142.
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