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Sitagliptin Found To Reduce Reactive Hypoglycemia Symptoms

According to a new study to be presented at The Endocrine Society's 94th Annual Meeting in Houston, using diabetes drug sitagliptin can reduce the severity of reactive hypoglycemia, a form of low blood sugar that occurs after a meal. "Further studies may determine if it is possible to use sitagliptin as a novel approach to treat this condition, for which there currently is no medical therapy," said the lead investigator, Francisco Gomez-Perez, MD, of Instituto Nacional de Ciencias Medicas y Nutricion SZ in Mexico City. Also called postprandial hypoglycemia, reactive hypoglycemia can occur in both diabetic and nondiabetic individuals, usually after eating carbohydrates, or sugars. Symptoms include anxiety, heart palpitations, tremor (shakiness), sweating, dizziness, tingling of the fingers, difficulty concentrating and weakness. Current treatment, which is not always successful, involves avoiding high-sugar foods and eating small portions throughout the day, Gomez-Perez said.

The presumed cause of reactive hypoglycemia is a delayed secretion of the hormone insulin in response to ingested carbohydrates, he said. Insulin is needed at the right time to take care of the rise in blood sugar that usually follows a meal.

Doctors prescribe sitagliptin (marketed as Januvia) to lower glucose, or blood sugar, levels in adults with Type 2 diabetes. Gomez-Perez and his co-workers hypothesized that this medication might reduce the symptoms of reactive hypoglycemia.

In 28 people with reactive hypoglycemia (24 women and four men), the researchers studied the effects of taking either a 100-milligram tablet of sitagliptin once a day or an identical-appearing but inactive placebo ("dummy") pill. Thirteen participants randomly received sitagliptin, and the other 15 got the placebo. The authors received placebo and sitagliptin as well as funding for study materials from the manufacturer, Merck.

Before and after two weeks of treatment, participants had a five-hour meal tolerance test to measure their insulin and blood sugar levels. This test consisted of taking blood samples shortly before and repeatedly after the subjects ate a 440-calorie meal. It contained 100 grams of carbohydrates, an amount that would usually trigger symptoms of reactive hypoglycemia in these patients. The first 30 minutes of the test was the early phase, and the period from one to five hours made up the late phase.

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Initial pretest insulin and glucose levels were similar between groups. In the late phase of the meal tolerance test, however, the group that received sitagliptin had significantly higher blood sugar levels, according to the abstract. This correlated with a reduced intensity of symptoms of low blood sugar. The sitagliptin-treated group reported that the intensity of their symptoms was much lower than that reported by the placebo group: 2 versus 5, respectively, on a scale of 0 to 10, with 0 indicating not present and 10 representing maximum intensity.

"Our results suggest that the reduction of hypoglycemia is related to an improvement in the secretion of insulin during the early phase of the meal tolerance test," Gomez-Perez said. "Sitagliptin appears to restore the normal dynamics of insulin secretion."

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Although he called the results "promising," he said more research is necessary before they can recommend sitagliptin for treatment of reactive hypoglycemia.

Source-Eurekalert

Low Blood Sugar Without Diabetes: Causes Of Reactive Hypoglycemia

Low blood sugar, or hypoglycemia, is common among people with diabetes. It occurs when blood sugar levels drop below 70 mg/dL, either due to excessive insulin, insufficient food intake, or increased physical activity. But did you know that blood sugar levels can drop even without diabetes? Here's what Dr Prabhat Ranjan Sinha, Senior Consultant-Internal Medicine, Aakash Healthcare, New Delhi, has to say about the condition.

What Is Reactive Hypoglycemia?

Reactive hypoglycemia refers to a drop in your blood sugar levels a few hours after eating, even when you're not diabetic, explains Dr Sinha.

"It typically sets in within about four hours following a meal, manifesting through symptoms such as anxiety, blurry vision, rapid heart rate, confusion, dizziness, irritability, headache, hunger, light-headedness, sweating, shaking, difficulty sleeping, feeling faint, extreme fatigue, and weakness," he shares further.

Also Read: 8 Warning Signs Of Low Blood Sugar Levels

This type of hypoglycemia is one of the two types of hypoglycemia not related to diabetes; the other one is fasting hypoglycemia, which happens when you don't eat for a long time.

Unlike diabetes-related hypoglycemia, which is caused by skipping meals, reactive hypoglycemia occurs exclusively after eating.

Causes Of Reactive Hypoglycemia

According to Dr Sinha, the exact cause isn't always clear, but it is often the result of the body producing excessive insulin in response to a large, carbohydrate-rich meal.

He says, "This surplus of insulin can persist even after digestion, leading to a drop in blood glucose levels below normal."

Other potential triggers include tumours, alcohol consumption, certain surgeries like gastric bypass or ulcer treatment, and some metabolic disorders, with a higher likelihood among overweight individuals, he adds.

What Is The Normal Range Of Blood Sugar In The Body?

In a fasting state, normal blood glucose concentrations typically fall between 70 mg/dL (3.9 mmol/L) and 100 mg/dL (5.6 mmol/L).

When blood sugar drops below 70 mg/dL (3.9 mmol/L), it's considered low, and levels at or below this point can pose risks to health.

How To Treat Low Blood Sugar?

When it comes to treating reactive hypoglycemia, the primary aim is to raise blood sugar levels and identify the underlying cause to prevent future episodes, says Dr Sinha.

He adds, "For individuals with diabetes, it's crucial to learn how to self-treat low blood sugar. This may involve consuming juice, eating food, or taking glucose tablets. Some may also need to administer a shot of glucagon to raise blood sugar levels. If low blood sugar is due to an insulinoma, surgery to remove the tumour is typically recommended."

Also Read: What Are Normal Blood Sugar Levels? Know Range And Remedies To Control

In the case of non-diabetics suffering from low blood sugar levels, the doctor recommends lifestyle changes. These include:

Eating small, regular meals and snacks every three hours.

Opting for a balanced diet that includes protein, fruits, vegetables, dairy products, and whole grains.

Avoid foods high in sugar and refined carbs, such as white bread.

Consuming food along with alcohol intake.

Incorporating regular exercise into your routine.

Conclusion

Managing and preventing low blood sugar in individuals with or without diabetes is paramount to avoiding potential complications. In addition to regular monitoring, one must also pay attention to the symptoms and receive immediate medical treatment. Preventive strategies involve eating a healthy, balanced diet coupled with regular exercise and limiting alcohol consumption.

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Does Your Head Usually Hurt After Lunch? You May Have Reactive Hypoglycemia

Although extreme cases of reactive hypoglycemia are very rare, doctors say that people with insulin resistance and those who are overweight or obese are vulnerable to this condition.

Reactive hypoglycemia refers to low blood sugar that occurs after a meal — usually within four hours after eating.(Shutterstock)

Insulin resistance is a risk factor for the development of Type-2 diabetes, which is increasing in epidemic proportions worldwide — and more so in India.

Postprandial hypoglycemia occurs when too much insulin is produced and released by the pancreas following a large carbohydrate-based meal.

"Reactive hypoglycemia refers to low blood sugar that occurs after a meal — usually within four hours after eating. This is different from low blood sugar (hypoglycemia) that occurs while fasting," Subhash Kumar Wangnoo, Senior Consultant Endocrinologist and Diabetologist at the capital's Indraprastha Apollo Hospital, said.

"People who have undergone bariatric surgery (for weight loss) are also more likely to get reactive hypoglycaemia," Wangnoo noted. "In those who have undergone bariatric surgery, the food can pass too quickly into the small intestine (dumping syndrome). As a result, the glucose in food is not absorbed resulting in hypoglycaemia.

"Also an uncommon complication of bariatric surgery is nesidioblastosis — a condition in which the insulin producing cells of the pancreas undergo hyperplasia, resulting in excess insulin production that can cause reactive hypoglycaemia," Wangnoo explained.

Signs and symptoms of reactive hypoglycemia include hunger, weakness, shakiness, sleepiness, sweating, light-headedness, headache, palpitations, irritability and anxiety.

"Increasing use of carbohydrates and fats and processed foods, along with reduced physical activity, are the underlying factors leading to the increasing prevalence of these conditions," Wangnoo said.

A study published in the journal Diabetologia detailed the history of three patients who did not have diabetes but who suffered so much from severe hypoglycemia following meals that they became confused and sometimes blacked out. Following weight loss surgery, all three patients — a woman in her 20s, another in her 60s and a man in his 40s — developed postprandial hypoglycemia that failed to respond to dietary or medical intervention.

The immediate cause of hypoglycemia was exceptionally high levels of insulin following meals. All three patients in the study failed to respond to medication and ultimately required partial or complete removal of the pancreas, the major source of insulin, to prevent dangerous declines in blood glucose.

Thankfully, most cases of postprandial hypoglycemia can be managed by simple modifications in the diet, according to the doctors.

After monitoring blood glucose levels hourly before and after a meal, Rahul's diet too was modified.

"Rahul takes small meals every four hours, exercises daily in the morning and his blood sugar level does not dip below 80 mg/dL. After two months, he seemed to have got rid of the symptoms he used to complain of," Ajmani said.

"Dietary modification with controlled carbohydrate content has been demonstrated to improve symptoms of postprandial hypoglycemia in bariatric surgery-associated hypoglycemia, dumping syndrome, insulin autoimmunity, and postprandial syndrome," Manoj Kumar, Consultant, Endocrinology Department, Jaypee Hospital, Noida, noted.

The doctors advised that patients diagnosed with the condition should have a balanced diet — high-fibre foods, non-meat source of protein, whole grains, fruits and vegetables. They should also avoid sugary food on an empty stomach.

"Avoid sugary soft drinks and eat several small meals and snacks throughout the day, no more than three hours apart during the waking hours," Ajmani said.

Patients with reactive hypoglycaemia should be screened for diabetes or later development of diabetes as they might be having prediabetes, Wangnoo pointed out.

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