Endocrine Abstracts

Although there are no formal diagnostic criteria, reactive hypoglycaemia is a term generally used to describe hypoglycaemia occurring within a few hours after meal intake where other causes of hypoglycaemia such as medications, cortisol deficiency and insulinoma have been excluded. Although this is considered a benign, easily managed condition here we present three cases of reactive hypoglycaemia with significant debilitating symptoms. The first case is a 26-year-old man who was referred to the Endocrine clinic following an episode of complete loss of consciousness after two pints of beer and another episode where he was found to be unrousable in the morning with a capillary blood glucose of 3.1mmol/l. He described a history of one stone weight loss over six months alongside symptoms of headache, dizziness, nausea and lethargy occurring 2–5 h after meals. An oral glucose tolerance test arranged by the general practitioner found capillary blood glucose of 2.7 mmol/l at 2 h. Subsequent extended oral glucose tolerance test over 5 h revealed symptomatic hypoglycaemia with serum glucose levels as low as 1.6 mmol/l at 2.5 h. The second case is a 58-year-old lady referred after having a pre-syncopal episode while driving and was found to have a capillary blood glucose of 3.0mmol/l in the Emergency Department. She also described episodes of feeling unsteady on her feet and her legs giving way associated with a craving for sweet foods a few hours after oral intake. There was nothing of note on her past medical history. She experienced symptomatic hypoglycaemia with a serum glucose of 3.9 mmol/l at 3 h following extended oral glucose tolerance test. The third case is a 44-year-old lady who presented with symptoms of dizziness and unsteadiness on her feet occurring around 3.5 h after eating lunch which resolved after having a sugary drink or food. Following an extended oral glucose tolerance test she experienced moderate hypoglycaemia with serum glucose of 2.3 mmol/l at 3 h with sweatiness and light-headedness.

Conclusion: The above three cases highlight the significant morbidity and potentially severe symptomatology associated with reactive hypoglycaemia. This should be considered in patients presenting with multiple symptomatology in particular syncope and pre-syncope following a meal as awareness of the same enables us to manage and control reactive hypoglycaemia by less but more frequent intake of a balanced diet.