Idiopathic Reactive Hypoglycemia: Mechanisms of Onset and Remission with High Protein Low Carbohydrate Diet ()
ABSTRACT
Objective: Idiopathic
reactive hypoglycemia is defined as early postprandial hypoglycemia occurring
on ingestion of high carbohydrate containing meal. Remission ensues with high
protein low carbohydrate diet. This study assessed roles of insulin and
glucagon in its onset and remission. Methods: Plasma glucose, insulin and
glucagon were determined after an overnight fast and repeatedly until 180 minutes
on ingestion of 3 meals; 100 g glucose; 100 g pure protein liquid and mixture
of 50 g each at 14 days’ interval. Five adults with IRH and 6 age matched
healthy volunteers participated. Results: In IRH, glucose ingestion induced
prompt rise in glucose (5.1 ± 0.8 to10.5
± 1.2 mM/L) followed later by hypoglycemia (2.6 ± 0.4 mM/L). Insulin rose from
7 ± 2 to 90 ± 18 mU/L. Glucagon
rose initially (10% ± 2%) from elevated basal concentration (373 ± 57 mU/L)
followed by later decline (-43% ± 12%). On protein ingestion, glucose declined
followed by a restoration to basal level while both insulin and glucagon rose
(28 ± 6 mU/L; 148% ± 38%, p < 0.01). However, insulin response was lower and
glucagon rise was greater when compared to responses on glucose ingestion (p <
0.01). With mixed meal, glucose (8.2 ± 0.6 mM/L), insulin (65 ± 12 mU/L) and
glucagon (48% ± 7%) responses were lesser than rises following glucose
ingestion (p < 0.05) and hypoglycemia did not occur. Conclusion: In IRH,
initial hyperglycemia on glucose ingestion may be exacerbated by paradoxical
glucagon rise and hypoglycemia may be induced by increased insulin and
declining glucagon responses. Resolution of hypoglycemia with high protein low
carbohydrate diet may be attributed to blunting of insulin response and
concurrent glucagon rise.
Share and Cite:
Prakash, K. , Kabadi, M. and Kabadi, U. (2015) Idiopathic Reactive Hypoglycemia: Mechanisms of Onset and Remission with High Protein Low Carbohydrate Diet.
Open Journal of Endocrine and Metabolic Diseases,
5, 117-123. doi:
10.4236/ojemd.2015.59015.