Classification of Hypoglycemia
Thereare 3 categories of clinical hypoglycemia: (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. An example is an insulinoma, an insulin-secreting tumor of the islets of Langerhans.
Reactive (postprandial) hypoglycemia occurs after ingesting food. The 3 sub-types of reactive (postprandial) hypoglycemia are: (1) alimentary; (2) associated with type 2 (noninsulin-dependent) diabetes mellitus; and (3) idiopathic. Patients who have undergone gastrointestinal surgery (eg, subtotal gastrectomy) experience reactive hypoglycemia within 2 to 3 hours after eating. 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. Patients with relatively mild noninsulin-dependent diabetes mellitus experience reactive hypoglycemia 3 to 5 hours after a meal. 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.
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.
Medscape Pharmacotherapy. 2002;4(1) © 2002 Medscape
Cite this: Factitious Hypoglycemia - Medscape - May 09, 2002.