Factitious Hypoglycemia


May 08, 2002

In This Article

Classification of Hypoglycemia

Thereare 3 categories of clinical hypoglycemia[13]: (1) fasting, (2) reactive or postprandial, and (3) drug-related.

Fasting hypoglycemia is defined as the inability to maintain glucose homeostasis in the postabsorptive, or fasting, state.[13] An example is an insulinoma, an insulin-secreting tumor of the islets of Langerhans.

Reactive (postprandial) hypoglycemia occurs after ingesting food.[13] The 3 sub-types of reactive (postprandial) hypoglycemia are: (1) alimentary; (2) associated with type 2 (noninsulin-dependent) diabetes mellitus; and (3) idiopathic.[13] Patients who have undergone gastrointestinal surgery (eg, subtotal gastrectomy) experience reactive hypoglycemia within 2 to 3 hours after eating.[11] Alimentary hypoglycemia occurs because an alteration in the rate of nutrients that are delivered to the small intestine leads to excess and poorly timed release of insulin.[13] Patients with relatively mild noninsulin-dependent diabetes mellitus experience reactive hypoglycemia 3 to 5 hours after a meal.[13] The reactive hypoglycemia may be related to the late and extended second phase of insulin secretion that is characteristic of type 2 diabetes mellitus. Idiopathic reactive hypoglycemia is a common cause of nonspecific symptoms such as depression and mood swings.[13]

Drug-related hypoglycemiais related to accidental or intentional administration of a drug (eg, insulin, sulfonylureas) that may occur in the both the fasting and postprandial states.[13]