Palardy J, Havrankova J, Lepage R, Matte R, Bélanger R, D'Amour P, Ste-Marie L G
Department of Medicine, Hôpital St.-Luc, Université de Montréal, Canada.
N Engl J Med. 1989 Nov 23;321(21):1421-5. doi: 10.1056/NEJM198911233212101.
Postprandial (reactive) hypoglycemia is a controversial disorder because its symptoms are not specific, the presence of symptoms often correlates weakly with blood glucose concentrations measured after oral glucose administration, and glucose levels have rarely been measured when symptoms have developed spontaneously. In this study, we measured blood glucose in 28 patients with suspected postprandial hypoglycemia while they were experiencing their typical symptoms, in capillary blood collected on filter paper. Five patients (18 percent) had symptoms of "hypoglycemia" that were associated with blood glucose levels of 2.8 mmol per liter (50 mg per deciliter) or less, and eight other patients (29 percent) had symptoms associated with glucose levels of 2.9 to 3.3 mmol per liter on at least one occasion. Six (5 percent) of 132 reported symptomatic episodes that were associated with blood glucose levels of 2.8 mmol per liter or less, and 16 (12 percent) with levels of 2.9 to 3.3 mmol per liter. In 140 measurements made in 17 normal subjects, blood glucose levels were never found to be less than 2.8 mmol per liter, and levels of 2.9 to 3.3 mmol per liter were found only twice. No specific symptom was associated with low glucose levels in the patients with suspected hypoglycemia. The relief of symptoms by ingesting food was more often associated with low than with normal blood glucose levels: 86 percent of episodes in which blood glucose values were less than or equal to 3.3 mmol per liter were relieved by eating, as compared with 53 percent of episodes in which values were more than 3.3 mmol per liter (P less than 0.007). No correlation was found between plasma glucose levels measured after oral glucose administration and blood glucose levels measured during symptoms. We conclude that postprandial hypoglycemia is infrequent, even in a referral population, and that recording blood glucose measurements during spontaneously occurring symptomatic episodes is necessary to establish the diagnosis since symptoms are not specific and oral glucose-tolerance testing is not helpful.
餐后（反应性）低血糖是一种存在争议的病症，因为其症状不具有特异性，症状的出现往往与口服葡萄糖后测得的血糖浓度相关性较弱，而且在症状自发出现时很少对血糖水平进行测量。在本研究中，我们对28例疑似餐后低血糖患者在出现典型症状时，采集其滤纸上的毛细血管血来测量血糖。5例患者（18%）出现“低血糖”症状时，血糖水平为2.8毫摩尔/升（50毫克/分升）或更低，另外8例患者（29%）至少有一次症状与血糖水平在2.9至3.3毫摩尔/升有关。在报告的132次有症状发作中，6次（5%）与血糖水平2.8毫摩尔/升或更低有关，16次（12%）与血糖水平2.9至3.3毫摩尔/升有关。在对17名正常受试者进行的140次测量中，从未发现血糖水平低于2.8毫摩尔/升，2.9至3.3毫摩尔/升的水平仅出现过两次。在疑似低血糖的患者中，没有特定症状与低血糖水平相关。通过进食缓解症状的情况在血糖水平低时比正常时更常见：血糖值小于或等于3.3毫摩尔/升的发作中，86%通过进食得到缓解，而血糖值大于3.3毫摩尔/升的发作中这一比例为53%（P<0.007）。口服葡萄糖后测得的血浆葡萄糖水平与症状发作时测得的血糖水平之间未发现相关性。我们得出结论，餐后低血糖很少见，即使在转诊人群中也是如此，而且由于症状不具特异性且口服糖耐量试验无助于诊断，因此在症状自发出现时记录血糖测量值对于确诊是必要的。
