Altuntaş Yüksel
Department of Endocrinology and Metabolism, University of Health Sciences Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul,Turkey.
Sisli Etfal Hastan Tip Bul. 2019 Aug 28;53(3):215-220. doi: 10.14744/SEMB.2019.59455. eCollection 2019.
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, AGİ, 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.
反应性低血糖（RH）是指进食后2 - 5小时出现的餐后低血糖状态。临床上，RH有三种不同形式：特发性RH（180分钟时）、食后性（120分钟内）和迟发性RH（240 - 300分钟时）。当第一相胰岛素反应降低时，首先，餐后血糖开始升高。这导致第二相胰岛素分泌延迟但过量。因此，发生迟发性反应性低血糖。胰岛素水平升高还会导致肌肉和脂肪细胞上胰岛素受体后下调，从而降低胰岛素敏感性。3小时时特发性反应性低血糖中胰岛素敏感性增加的原因尚不完全清楚。然而，4或5小时时迟发性反应性低血糖中胰岛素敏感性降低。因此，4或5小时出现低血糖且有糖尿病家族史和肥胖的患者可能比3小时出现低血糖的患者更容易患糖尿病。我们认为，口服葡萄糖耐量试验（OGTT）中糖耐量正常的一些病例，在OGTT后4 - 5小时血糖<55或60mg/dl时应被视为糖尿病前期。如果存在伴有空腹血糖受损（IFG）的迟发性RH，可能推荐使用二甲双胍和α-糖苷酶抑制剂（AGI）治疗。如果存在伴有糖耐量受损（IGT）的迟发性RH，也可能推荐使用二甲双胍、AGI、噻唑烷二酮（TZD）、二肽基肽酶-4抑制剂（DPP-IV抑制剂）、胰高血糖素样肽-1受体激动剂（GLP1RA）治疗。因此，餐后RH（<55或60mg/dl），尤其是4小时后，可能预示糖尿病。因此，伴有体重增加且有家族糖尿病史的RH患者将受益于生活方式改变以及预防糖尿病的适当抗糖尿病方法。
