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Defining and Characterizing Postprandial Reactive Hypoglycemia.

S Katherine Sweatt1, Diana M Thomas2, G Jake LaPorte2

  • 1Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35205, USA.

Nutrients
|March 14, 2026

View abstract on PubMed

Summary
This summary is machine-generated.

Reactive hypoglycemia (RH) in individuals with obesity is linked to higher insulin sensitivity and disposition index. A new method using mixed meal tests defines RH with curve parameters, aiding diagnosis.

Keywords:
hungerinsulin sensitivityobesityreactive hypoglycemia

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Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Clinical Nutrition

Background:

  • Reactive hypoglycemia (RH) is associated with obesity and type 2 diabetes risk.
  • Clear diagnostic criteria for RH are lacking.
  • Obesity complicates the identification and understanding of RH.

Purpose of the Study:

  • To define reactive hypoglycemia (RH) in adults with obesity using calculus-based curve parameters from a mixed macronutrient liquid meal test (MMTT).
  • To characterize RH by assessing insulin sensitivity, acute insulin response to glucose (AIRg), insulin clearance, and disposition index using an intravenous glucose tolerance test (IVGTT).
  • To introduce a novel, reproducible method for RH definition.

Main Methods:

  • A 4-hour MMTT was conducted on 69 non-diabetic adults with obesity (BMI 32.3 ± 4.2 kg/m²).
  • An IVGTT was performed to characterize metabolic parameters in participants with and without RH.
  • Curve parameters from the MMTT were used to define RH, with visual analog scales assessing hunger and fullness.

    • Main Results:

    • Reactive hypoglycemia (RH) was identified in 19 out of 69 participants based on MMTT curve properties.
    • Individuals with RH exhibited lower glucose AUC and nadir, earlier glucose nadir timing, and higher insulin sensitivity compared to non-RH.
    • Female sex and African American race were significant predictors for the presence of RH.

    Conclusions:

    • Reactive hypoglycemia (RH) in individuals with obesity is characterized by enhanced insulin sensitivity and a greater disposition index.
    • A novel, reproducible method for defining RH using MMTT curve-based criteria integrated with IVGTT outcomes is presented.
    • This approach aids in the identification of RH, potentially improving management strategies for associated metabolic conditions.