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Approach to the patient with postprandial hypoglycemia
Sandi-Jo Galati1, Elliot J Rayfield1
1Icahn School of Medicine at Mount Sinai, Department of Medicine, Division of Endocrinology, Diabetes and Bone Diseases, New York, New York.
Summary
Postprandial hypoglycemia in nondiabetic individuals presents a diagnostic challenge. This review covers recent syndromes like noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS) and postbariatric surgery hypoglycemia, discussing diagnosis and management.
Area of Science:
- Endocrinology
- Gastroenterology
Background:
- Postprandial hypoglycemia is a common complaint in nondiabetic patients, posing diagnostic difficulties.
- Understanding its various causes is crucial for effective patient management.
Purpose of the Study:
- To review the current understanding of postprandial hypoglycemia in nondiabetic individuals.
- To highlight recently described syndromes and their diagnostic and management strategies.
Main Methods:
- Literature search of PubMed for articles on "postprandial hypoglycemia," "reactive hypoglycemia," and "hyperinsulinemic hypoglycemia" within the last 40 years.
- Inclusion of clinically relevant publications for comprehensive review.
Main Results:
- Hypoglycemia evaluation categorizes patients into well-appearing and ill-appearing groups.
- Potential causes in well-appearing patients include insulinoma, noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS), postbariatric surgery hypoglycemia, dumping syndrome, insulin autoimmunity, and postprandial syndrome.
- Limited randomized clinical trials exist for optimal diagnosis and treatment due to disease rarity and recent descriptions.
Conclusions:
- This review synthesizes pathophysiologic mechanisms of postprandial hypoglycemia.
- Focus is placed on newer syndromes like NIPHS and postbariatric surgery hypoglycemia.
- Diagnostic and management approaches are discussed.
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