SFEEU2024 Society for Endocrinology Clinical Update 2024 Workshop H: Miscellaneous endocrine and metabolic disorders (19 abstracts)
Metformin- a novel approach to managing reactive hypoglycaemia in patients with pre-diabetes and diabetes
Komal Zia Rao 1 , Kavitha Lakshmipathy 1 , Younes R. Younes 1 , Benjamin C.T. Field 1,2 , Vidhu Nayyar 1 , James Clark 1 , Sunil Zachariah 1 & Julian Emmanuel 1
1East Surrey Hospital, Surrey & Sussex Healthcare NHS Trust, Redhill, United Kingdom.; 2Section of Clinical Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
A 70-year old gentleman was referred to the endocrine clinic by the Cardiology team following an admission with blackouts- three in three years, two causing road traffic accidents. During one of the accidents, his capillary blood glucose reading dropped below 3 mmol/l. The patient reported dizzy spells, accompanied by hot flushes, sweats, tremor, change in colour- “looking grey”, feeling hungry and nausea, alleviated by sugary snacks. These episodes were linked to missing meals and consuming sweet snacks following a meal. Despite extensive investigations- 24-hour ECG, echocardiogram and implantable loop recorder, a cardiac cause could not be identified. He was also known to have pancreatic insufficiency. His HbA1 c was in keeping with pre-diabetes. Glucose monitoring at home revealed capillary readings ranging from 4.8-7.4 mmol/l, and peaking at 10-13.5 mmol/l after meals. Investigations; urinary metanephrines and cortisol were within range. HbA1 c indicated pre-diabetes (46 mmol/mol). Mixed meal test showed significant glucose variability of >7 mmol/l, an exaggerated insulin response (C-peptide 1687 pmol/l, insulin 317 pmol/l) and hyperglycaemia (blood glucose 12.2 mmol/l). He was diagnosed with reactive hypoglycaemia. He was advised to adopt a low glycaemic index diet and Metformin initiated, titrated to maximum dose, aiming to improve insulin sensitivity, and prevent recurrence of hypoglycaemia. Remarkably, he did not experience recurrence of symptoms. This case underscores the potential role of metformin as an effective treatment strategy for managing reactive hypoglycaemia in patients with pre-diabetes.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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