User:Alteripse/hypoglycemia workshop
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Reactive hypoglycemia is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring 1-6 hours after a high carbohydrate meal (or oral glucose). It is thought to represent a consequence of release of more insulin than is required for digestion and disposal of the glucose derived from the meal. Both the diagnostic criteria and the prevalence of reactive hypoglycemia are controversial. Severe effects on the brain such as seizures or obvious permanent brain damage are rare. The most commonly recommended treatment is alteration of eating pattern to slow the speed of carbohydrate digestion and reduce the number of hours between meals. Other, more controversial, diet changes or treatments are sometimes recommended.
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[edit] Definitions and diagnostic criteria
A number of stricter or looser definitions have been used in different contexts, and there is no universally accepted diagnostic test.
The strictest definition applies the diagnosis only to those conditions in which hypoglycemic signs and symptoms occur 1-6 hours after meals, accompanied by a measurably low blood glucose (typically below 50 mg/dL or 2.8 mmol/L) and promptly relieved by eating or drinking a moderate amount of sugar-containing food or drink. The requirement that the symptoms be linked to a demonstrably low glucose are referred to as the Whipple criteria. This definition and diagnostic criteria are preferred by most endocrinologists and other physicians familiar with other types of hypoglycemia.
In contrast, the broadest definition of reactive hypoglycemia simply equates the term with any hypoglycemic symptoms occurring in any pattern, without demonstration of low blood glucose level. In these contexts the most commonly described symptoms are fatigue or weakness, hunger, difficulty concentrating, impaired mood, and shakiness, but many additional symptoms are often described. The broader definitions are usually preferred by persons with minimal experience with other forms of hypoglycemia, by lay persons who practice or advocate particular eating patterns, and by many whose philosophy, business, or practices fall within the broad definition of alternative medicine. Most of these people consider the terms hypoglycemia, idiopathic hypoglycemia, and reactive hypoglycemia to be interchangeable and have no experience with, or need to recognize, the range of other forms of hypoglycemia.
Advocates of the stricter usage argue that the medical term "hypoglycemia" should be reserved for those whose symptoms can be demonstrably related to measurable low glucose levels. They argue that it is misleading and unhelpful to apply the term to a combination of symptoms with no demonstrable abnormality of carbohydrate metabolism, and have suggested other terms such as idiopathic postprandial syndrome, pseudohypoglycemia, or non-hypoglycemia or for the symptom complex without low glucose levels.
The disparity of usages developed out of circumstances described in the history section below, and persists for several reasons, but primarily because of the difficulty of obtaining accurate blood glucose measurements at the time a person has symptoms attributable to hypoglycemia. In nearly all forms of episodic hypoglycemia due to other causes an abnormality of glucose metabolism can be detected by laboratory testing (see hypoglycemia for an extensive description and examples). However, such an abnormality is demonstrable for only a small number of the people with symptoms suggestive of reactive hypoglycemia.
, and because many healthy people can have glucose tolerance test patterns said to be characteristic of reactive hypoglycemia. It has been proposed that the term reactive hypoglycemia be reserved for the pattern of postprandial hypoglycemia which meets the Whipple criteria (symptoms correspond to measurably low glucose and are relieved by raising the glucose), and that the
