Diagnosis and classification of reactive hypoglycemia based on hormonal changes in response to oral and intravenous glucose administration

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Abstract
Reactive hypoglycemia encompasses a spectrum of disorders which includes early alimentary reactive hypoglycemia, late diabetic reactive hypoglycemia, hormonal deficiency states with hypoglycemia, and idiopathic hypoglycemia. Transitional “hypoglycemia” should not be mistaken for one of the reactive-hypoglycemic states. Based on the approach we have proposed, the patient may be diagnosed after a 2-day evaluation that includes an OGTT and IVGTT. During the OGTT, particular attention is paid to the configuration of the glucose and insulin curves and posthypoglycemic cortisol and growth hormone responses. The occurrence of typical symptoms at the nadir of blood glucose is an adequate indicator of an intact catecholamine system. An IVGTT separates the diabetic patients into insulinopenic and insulinoplethoric groups. Based on the specific hypoglycemic disorder present, rational treatment may be instituted (22, 30, 56–58).