CoChat
Sign Up
Cited by 21Diabetes Management and ResearchPancreatic function and diabetesDiabetes, Cardiovascular Risks, and Lipoproteins

Metabolic Parameters in Patients with Suspected Reactive Hypoglycemia

Open access
Hall, Marianna, Walicka, Magdalena, Panczyk, Mariusz, Traczyk, Iwona·2021·Journal of Personalized Medicine
DOI 10.3390/jpm11040276PMC PMC8067537
Open this paper in CoChat — free accountOpen PDF

Abstract

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.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.3390/jpm11040276

Cites

4 of 4 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • RH is frequently observed in individuals with insulin resistance, hyperinsulinemia, or prediabetes.

    “RH is frequently observed in individuals with insulin resistance, hyperinsulinemia, or prediabetes, where insulin secretion is disproportionately high relative to carbohydrate intake [2,3].”

    From Defining and Characterizing Postprandial Reactive Hypoglycemia (2026) · cites this paper as [2]

    The Introduction says RH may be related to insulin resistance, hyperinsulinemia, or prediabetes, but does not say it is frequently observed in those groups. The Results (§§3.4–3.5; page unavailable) report that only one patient with confirmed RH had insulin resistance and that hyperinsulinemia did not differ significantly by RH diagnosis. The Discussion (§4; page unavailable) also reports lower insulin values in patients with confirmed RH, contrary to the claimed disproportionately high secretion. (LLM, conf=0.88)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • Symptoms can occur at glucose levels above 70 mg/dL.

    “There are reports, however, that symptoms can occur at glucose levels above 70 mg/dL [2].”

    From Defining and Characterizing Postprandial Reactive Hypoglycemia (2026) · cites this paper as [2]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 42

  1. [1]Zheng Y. Ley S.H. Hu F.B. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications Nat. Rev. Endocrinol. 2018 14 88 98 10.1038/nrendo.2017.151 29219149 · DOI · Paper page
  2. [2]Brun J.F. Fedou C. Mercier J. Postprandial reactive hypoglycemia Diabetes Metab. 2000 26 337 351 11119013
  3. [4]Mumm H. Altinok M.L. Henriksen J.E. Ravn P. Glintborg D. Andersen M. Prevalence and possible mechanisms of reactive hypoglycemia in polycystic ovary syndrome Hum. Reprod. 2016 31 1105 1112 10.1093/humrep/dew046 27008892 · DOI
  4. [5]Mongraw-Chaffin M. Beavers D.P. McClain D.A. Hypoglycemic symptoms in the absence of diabetes: Pilot evidence of clinical hypoglycemia in young women J. Clin. Transl. Endocrinol. 2019 18 100202 10.1016/j.jcte.2019.100202 31428564 PMC6695274 · DOI
  5. [6]Simpson E.J. Holdsworth M. Macdonald I.A. Interstitial glucose profile associated with symptoms attributed to hypoglycemia by otherwise healthy women Am. J. Clin. Nutr. 2008 87 354 361 10.1093/ajcn/87.2.354 18258625 · DOI
  6. [7]Lefebvre P.J. Andreani D. Marks V. Creutzfeldt W. Statement on Post-prandial or Reactive Hypoglycaemia Diabet. Med. 1988 5 200 10.1111/j.1464-5491.1988.tb00968.x 2964986 · DOI
  7. [8]Eckert-Norton M. Kirk S. Non-diabetic hypoglycemia J. Clin. Endocrinol. Metab. 2013 98 39A 40A 10.1210/jc.2013-v98i10.39A 24098022 · DOI
  8. [9]Stanley S. Moheet A. Seaquist E.R. Central Mechanisms of Glucose Sensing and Counterregulation in Defense of Hypoglycemia Endocr. Rev. 2019 40 768 788 10.1210/er.2018-00226 30689785 PMC6505456 · DOI · Paper page
  9. [10]Chalew S.A. Koetter H. Hoffman S. Levin P.A. Kowarski A.A. Diagnosis of Reactive Hypoglycemia: Pitfalls in the Use of the Oral Glucose Tolerance Test South. Med. J. 1986 79 285 287 10.1097/00007611-198603000-00006 3952536 · DOI · Paper page
  10. [11]Eyth E. Basit H. Smith C. Glucose Tolerance Test StatPearls Publishing Treasure Island, FL, USA 2020 30422510
  11. [12]Saha B. Post prandial plasma glucose level less than the fasting level in otherwise healthy individuals during routine screening Indian J. Clin. Biochem. 2006 21 67 71 10.1007/BF02912915 23105617 PMC3453979 · DOI
  12. [15]Bjornstad P. Eckel R.H. Pathogenesis of Lipid Disorders in Insulin Resistance: A Brief Review Curr. Diabetes Rep. 2018 18 127 10.1007/s11892-018-1101-6 30328521 PMC6428207 · DOI
  13. [16]Pantoja-Torres B. Toro-Huamanchumo C.J. Urrunaga-Pastor D. Guarnizo-Poma M. Lazaro-Alcantara H. Paico-Palacios S. Ranilla-Seguin V.D.C. Benites-Zapata V.A. High triglycerides to HDL-cholesterol ratio is associated with insulin resistance in normal-weight healthy adults Diabetes Metab. Syndr. Clin. Res. Rev. 2019 13 382 388 10.1016/j.dsx.2018.10.006 30641729 · DOI
  14. [17]Wallick A. Caine-Bish N. Differences in Body Dissatisfaction With Respect to BMI Classification and Gender J. Nutr. Educ. Behav. 2010 42 S118 10.1016/j.jneb.2010.03.124 · DOI
  15. [18]Martens P. Tits J. Approach to the patient with spontaneous hypoglycemia Eur. J. Intern. Med. 2014 25 415 421 10.1016/j.ejim.2014.02.011 24641805 · DOI
  16. [19]Fu Z. Gilbert E.R. Liu D. Regulation of insulin synthesis and secretion and pancreatic Beta-cell dysfunction in diabetes Curr. Diabetes Rev. 2013 9 25 53 10.2174/157339913804143225 22974359 PMC3934755 · DOI
  17. [20]Shashaj B. Luciano R. Contoli B. Morino G.S. Spreghini M.R. Rustico C. Sforza R.W. Dallapiccola B. Manco M. Reference ranges of HOMA-IR in normal-weight and obese young Caucasians Acta Diabetol. 2015 53 251 260 10.1007/s00592-015-0782-4 26070771 · DOI
  18. [21]Tang Q. Li X. Song P. Xu L. Optimal cut-off values for the homeostasis model assessment of insulin resistance (HOMA-IR) and pre-diabetes screening: Developments in research and prospects for the future Drug Discov. Ther. 2015 9 380 385 10.5582/ddt.2015.01207 26781921 · DOI · Paper page
  19. [22]Lv X. Fang K. Hao W. Han Y. Yang N. Yu Q. Identification of Reactive Hypoglycemia with Different Basic BMI and Its Causes by Prolonged Oral Glucose Tolerance Test Diabetes Metab. Syndr. Obes. Targets Ther. 2020 13 4717 4726 10.2147/DMSO.S280084 PMC7719337 33293845 · DOI
  20. [23]Delibas I.B. Tanrıverdi S. Cakmak B. Does reactive hypoglycemia during the 100 g oral glucose tolerance test adversely affect perinatal outcomes? Ginekol. Polska 2018 89 25 29 10.5603/GP.a2018.0005 29411343 · DOI · Paper page
  21. [24]Glintborg D. Mumm H. Holst J.J. Andersen M. Effect of oral contraceptives and/or metformin on GLP-1 secretion and reactive hypoglycaemia in polycystic ovary syndrome Endocr. Connect. 2017 6 267 277 10.1530/EC-17-0034 28432082 PMC5457494 · DOI
  22. [25]Murata M. Adachi H. Oshima S. Kurabayashi M. Asymptomatic Reactive Hypoglycemia and Inflammatory Reaction in Patients with Coronary Artery Disease Int. Heart J. 2018 59 705 712 10.1536/ihj.17-245 29877300 · DOI
  23. [26]Yasuhara D. Kojima S. Naruo T. Inui A. Relationship between pretreatment laboratory-measured episodes of reactive hypoglycemia and short-term weight restoration in anorexia nervosa: A preliminary study Psychoneuroendocrinology 2006 31 452 458 10.1016/j.psyneuen.2005.11.002 16378696 · DOI
  24. [27]Johnson D.D. Dorr K.E. Swenson W.M. Service F.J. Reactive Hypoglycemia JAMA 1980 243 1151 1155 10.1001/jama.1980.03300370025021 7359666 · DOI
  25. [28]Oba-Yamamoto C. Takeuchi J. Nakamura A. Takikawa R. Ozaki A. Nomoto H. Kameda H. Cho K.Y. Atsumi T. Miyoshi H. Combination of alcohol and glucose consumption as a risk to induce reactive hypoglycemia J. Diabetes Investig. 2020 10.1111/jdi.13375 PMC8015820 33448697 · DOI
  26. [29]Sussman K.E. Stimmler L. Birenboim H. Plasma Insulin Levels During Reactive Hypoglycemia Diabetes 1966 15 1 4 10.2337/diab.15.1.1 5907146 · DOI
  27. [30]Luyckx A.S. Lefebvre P.J. Plasma Insulin in Reactive Hypoglycemia Diabetes 1971 20 435 442 10.2337/diab.20.6.435 5556902 · DOI
  28. [31]Hofeldt F.D. Lufkin E.G. Hagler L. Block M.B. Dippe S.E. Davis J.W. Levin S.R. Forsham P.H. Herman R.H. Are Abnormalities in Insulin Secretion Responsible for Reactive Hypoglycemia? Diabetes 1974 23 589 596 10.2337/diab.23.7.589 4841143 · DOI
  29. [32]Ensling M. Steinmann W. Whaley-Connell A. Hypoglycemia: A Possible Link between Insulin Resistance, Metabolic Dyslipidemia, and Heart and Kidney Disease (the Cardiorenal Syndrome) Cardiorenal Med. 2011 1 67 74 10.1159/000322886 22258467 PMC3101522 · DOI
  30. [33]Corkey B.E. Banting Lecture 2011: Hyperinsulinemia: Cause or Consequence? Diabetes 2011 61 4 13 10.2337/db11-1483 22187369 PMC3237642 · DOI
  31. [34]Carmina E. Stanczyk F.Z. Lobo R.A. Evaluation of Hormonal Status Yen and Jaffe’s Reproductive Endocrinology Elsevier Amsterdam, The Netherlands 2019 887 915
  32. [35]Yang G. Li C. Gong Y. Fang F. Tian H. Li J. Cheng X. Assessment of Insulin Resistance in Subjects with Normal Glucose Tolerance, Hyperinsulinemia with Normal Blood Glucose Tolerance, Impaired Glucose Tolerance, and Newly Diagnosed Type 2 Diabetes (Prediabetes Insulin Resistance Research) J. Diabetes Res. 2016 2016 1 11 10.1155/2016/9270768 PMC4685128 26770991 · DOI
  33. [36]Thomas D.D. Corkey B.E. Istfan N.W. Apovian C.M. Hyperinsulinemia: An Early Indicator of Metabolic Dysfunction J. Endocr. Soc. 2019 3 1727 1747 10.1210/js.2019-00065 31528832 PMC6735759 · DOI
  34. [37]Sprague J.E. Arbeláez A.M. Glucose counterregulatory responses to hypoglycemia Pediatr. Endocrinol. Rev. 2011 9 463 475 22783644 PMC3755377
  35. [38]Piziak V.K. Cryar A.K. Hypoglycemic Disorders N. Engl. J. Med. 1995 333 1154 1155 10.1056/nejm199510263331715 7565963 · DOI
  36. [39]Tsypes A. Aldao A. Mennin D.S. Emotion dysregulation and sleep difficulties in generalized anxiety disorder J. Anxiety Disord. 2013 27 197 203 10.1016/j.janxdis.2013.01.008 23474909 · DOI
  37. [40]Aucoin M. Bhardwaj S. Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification Case Rep. Psychiatry 2016 2016 1 4 10.1155/2016/7165425 PMC4963565 27493821 · DOI
  38. [41]Sørensen M. Johansen O.E. Idiopathic reactive hypoglycaemia—Prevalence and effect of fibre on glucose excursions Scand. J. Clin. Lab. Investig. 2010 70 385 391 10.3109/00365513.2010.491869 20509823 · DOI
  39. [43]Ma M. Liu H. Yu J. He S. Li P. Ma C. Zhang H. Xu L. Ping F. Li W. Triglyceride is independently correlated with insulin resistance and islet beta cell function: A study in population with different glucose and lipid metabolism states Lipids Health Dis. 2020 19 1 12 10.1186/s12944-020-01303-w 32487177 PMC7268278 · DOI
  40. [44]Natali A. Baldi S. Bonnet F. Petrie J. Trifirò S. Tricò D. Mari A. Plasma HDL-cholesterol and triglycerides, but not LDL-cholesterol, are associated with insulin secretion in non-diabetic subjects Metabolism 2017 69 33 42 10.1016/j.metabol.2017.01.001 28285650 · DOI
  41. [45]Biddinger S.B. Hernandez-Ono A. Rask-Madsen C. Haas J.T. Alemán J.O. Suzuki R. Scapa E.F. Agarwal C. Carey M.C. Stephanopoulos G. Hepatic Insulin Resistance Is Sufficient to Produce Dyslipidemia and Susceptibility to Atherosclerosis Cell Metab. 2008 7 125 134 10.1016/j.cmet.2007.11.013 18249172 PMC4251554 · DOI · Paper page
  42. [46]Prasun P. Mitochondrial dysfunction in metabolic syndrome Biochim. Biophys. Acta (BBA) Mol. Basis Dis. 2020 1866 165838 10.1016/j.bbadis.2020.165838 32428560 · DOI

Cited by

Sorted by citations

Authors
Hall, M., Walicka, M., Panczyk, M., & Traczyk, I.
Affiliations
  • Medical University of Warsaw (PL)
  • Central Clinical Hospital (PL)
  • Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland
Corresponding author
Hall, Marianna
ORCID
Venue
Journal of Personalized Medicine
Publisher
MDPI AG
Published
2021-04-07
Volume
11
Issue
4
Pages
276
ISSN
2075-4426 (ISSN-L)
DOI
10.3390/jpm11040276
PMC
PMC8067537
OpenAlex
W3145371039
Cited by
21
References
4
Citations by year
2026: 7 · 2025: 5 · 2024: 1 · 2023: 3 · 2022: 5
FWCI
1.68
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Personalized Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
insulin secretion, insulin resistance, HOMA-IR, oral glucose tolerance test, mixed meal tolerance test, fasting blood glucose, insulin levels, lipid profile, total cholesterol, hypoglycemic symptoms, non-diabetic patients, psychosomatic disorders, dietary habits, metabolic disorders, psychosomatic medicine

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review