Differential Diagnosis

Studies using finger-prick blood sampling during spontaneous symptomatic episodes have shown that only a very small proportion of sufferers from the postprandial syndrome have hypoglycemia at the relevant time. Of those who do, a substantial proportion have an identifiable cause for it. The commonest is partial gastrectomy and rapid gastric emptying from any cause, in the West, and the autoimmune insulin syndrome in the Far East, i.e., Japan. Other more rare causes include insulinoma, the newly described condition of noninsulinoma pancreatogenic hypoglycemia, and abnormalities of GLP-1 secretion.

In some people reactive hypoglycemia occurs only in response to a specific dietary indiscretion: for example, ingestion of large amounts of gin (alcohol) and tonic (sugar and quinine) on an empty stomach. A hard core of subjects remains for whom no satisfactory pathogenic mechanism can be identified. Only in them is it justified to describe them as suffering from (idiopathic or functional) reactive hypoglycemia (Figure 2).

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