Skip to main content
NCBI home page
Indian Journal of Clinical Biochemistry logoLink to Indian Journal of Clinical Biochemistry
. 2006 Sep;21(2):67–71. doi: 10.1007/BF02912915

Post prandial plasma glucose level less than the fasting level in otherwise healthy individuals during routine screening

Biswajit Saha 1,✉
PMCID: PMC3453979  PMID: 23105617

Abstract

During routine screening, some otherwise healthy individuals who showed remarkably lower post prandial (at 2 hour) plasma glucose without any symptom were subjected to extended glucose tolerance test and a few of them to extended post meal tolerance test as well. It was observed that post prandial (at 2 hour) plasma glucose after glucose administration was significantly lower than the fasting level (p<0.05−p<0.001). However, post prandial plasma glucose at 2 hour after their usual meal exhibited a significantly higher level than the fasting and post glucose level (p<0.05−p<0.001). Glucose appears to be a stronger agent than the more natural mixed meal in these individuals in causing post prandial lowering of plasma glucose. Hence, these individuals are to be evaluated with their usual meals before considering further investigations. Like upper limit, there is the need to have a consensus lower limit of reference interval of blood glucose level.

Key words: Plasma glucose, Idiopathic reactive hypoglycemia, Extended glucose tolerance test, Extended meal tolerance test

Full Text

The Full Text of this article is available as a PDF (71.7 KB).

References

  • 1.Charles M.A., Hofeldt F., Shackelford A., Waldeck N., Dodson L.E., Bunker J.D., Coggins J.T., Eichner H. Comparison of oral glucose tolerance tests and mixed meals in patients with apparent idiopathic postabsorptive hypoglycaemia—absence of hypoglycaemia after meals. Diabetes. 1981;30:465–470. doi: 10.2337/diabetes.30.6.465. [DOI] [PubMed] [Google Scholar]
  • 2.Hogan M.J., Service F.J., Sharbrough F.W., Gerich J.E. Oral glucose tolerance test compared with mixed meal in the diagnosis of reactive hypoglycaemia. A caveat on stimulation. Mayo Clin. Proc. 1983;58(8):491–496. [PubMed] [Google Scholar]
  • 3.Buss R.W., Kansal P.C., Roddam R.F., Pino J., Boshell B.R. Mixed meal tolerance test and reactive hypoglycemia. Horm. Metab. Res. 1982;14(6):281–283. doi: 10.1055/s-2007-1018995. [DOI] [PubMed] [Google Scholar]
  • 4.Lev-Ran A., Anderson R.W. The diagnosis of postprandial hypoglycaemia. Diabetes. 1981;30:996–999. doi: 10.2337/diabetes.30.12.996. [DOI] [PubMed] [Google Scholar]
  • 5.Palardy J., Havarankova J., Lepage R., Matte R., Belanger R., D'Amour P., Ste-Marie L.G. Blood glucose measurements during symptomatic episodes in patients with suspected postprandial hypoglycaemia. N. Engl. J. Med. 1989;321(21):1421–1425. doi: 10.1056/NEJM198911233212101. [DOI] [PubMed] [Google Scholar]
  • 6.Tamburrano G., Leonetti F., Sbraccia P., Giaccari A., Locuratolo N., Lala A. Increased insulin sensitivity in patients with idiopathic reactive hypoglycemia. J. Clin. Endocrinol. Metab. 1989;69:885–890. doi: 10.1210/jcem-69-4-885. [DOI] [PubMed] [Google Scholar]
  • 7.Davis M.R., Mellman M., Shamoon H. Physiologic hyperinsulinemia enhances counterregulatory hormone response to hypoglycaemia in IDDM. J. Clin. Endocrinol. Metab. 1993;76:1383–1385. doi: 10.1210/jc.76.5.1383. [DOI] [PubMed] [Google Scholar]
  • 8.Brun J.F., Bouix O., Monnier J.F., Blachon C., Jourdan N., Baccara M.T., Fedon C., Orsetti A. Increased insulin sensitivity and basal insulin effectiveness in postprandial reactive hypoglycaemia. Acta Diabetol. 1996;33(1):1–6. doi: 10.1007/BF00571932. [DOI] [PubMed] [Google Scholar]
  • 9.Leonetti F., Foniciello M., Iozzo P., Riggio O., Merli M., Giovannetti P., Sbraccia P., Giaccri A., Tamurrno G. Increased nonoxidative glucose metabolism in idiopathic reactive hypoglycemia. Metabolism. 1996;45:606–610. doi: 10.1016/S0026-0495(96)90031-1. [DOI] [PubMed] [Google Scholar]
  • 10.Owada K., Wasada T., Miyazono Y., Yoshino H., Hasumi S., Kuroki H., Yano K., Maruyama A., Kawai A., Omori Y. Highly increased insulin secretion in a patient with postprandial hypoglycemia: role of glucagons-like-peptide-1(7–36) amide. Endocr. J. 1995;42:147–151. doi: 10.1507/endocrj.42.147. [DOI] [PubMed] [Google Scholar]
  • 11.Toft N.M., Madsbad S., Holst J.J. Exaggerated secretion of glucagons-like peptide-1 (GLP-1) could cause reactive hypoglycaemia. Diabetologia. 1998;41:1180–1186. doi: 10.1007/s001250051049. [DOI] [PubMed] [Google Scholar]
  • 12.Gebhard B., Holst J.J., Biegelmayer C., Miholic J. Post prandial GLP-1, norepinephrine and reactive hypoglycaemia in dumping syndrome. Dig. Dis. Sci. 2001;46(9):1915–1923. doi: 10.1023/A:1010635131228. [DOI] [PubMed] [Google Scholar]
  • 13.Leonetti F., Morviducci L., Giaccari A., Sbraccia P., Caiola S., Zorretta D., Lostia O., Tamburrano G. Idiopathic reactive hypoglycemia: a role for glucagons. J. Endocrinol. Invest. 1992;15:273–278. doi: 10.1007/BF03348727. [DOI] [PubMed] [Google Scholar]
  • 14.Ahmadpour S., Kabadi U.M. Pancreatic alpha-cell function in idiopathic reactive hypoglycemia. Metabolism. 1997;46:639–643. doi: 10.1016/S0026-0495(97)90006-8. [DOI] [PubMed] [Google Scholar]
  • 15.Goodpaster B.H., Kelley D.E., Wing R.R., Meier A., Thaete F.L. Effects of weight loss on regional fat distribution and insulin sensitivity in obesity. Diabetes. 1999;48:839–847. doi: 10.2337/diabetes.48.4.839. [DOI] [PubMed] [Google Scholar]
  • 16.Raynaud E., Perez M.A., Brun J.F., Fedou C., Mercier J. Insulin sensitivity measured with the minimal model is higher in moderately overweight women with predominantly lower body fat. Horm Metab Res. 1999;31:415–417. doi: 10.1055/s-2007-978765. [DOI] [PubMed] [Google Scholar]
  • 17.Lefebvre P.J., Andreani D., Marks V., Creutzfeld W. Statement on Postprandial or reactive hypoglycaemia. Diabetes care. 1988;11:439–439. doi: 10.2337/diacare.11.5.439b. [DOI] [PubMed] [Google Scholar]
  • 18.Frier B.M., Fisher B.M. Diabetes Mellitus. In: Haslett C., Chilvers E.R., Boon N.A., Nicholas A., Hunter J.A.A., Colledge N.R., editors. Davidson's principles and practice of medicine. Edinburgh: Churchill Livingstone; 2002. pp. 641–82. [Google Scholar]
  • 19.Marks V. Hypoglycaemia. In: Warrell DA, Cox TM, Firth JD, Benz EJ, editors. Oxford textbook of medicine. Oxford: Oxford University press; 2003. pp. 362–369. [Google Scholar]
  • 20.Cryser P.E. Hypoglycemia. In: Kasper D.L., Braunwald E., Fauci A.S., Houser S.L., Longo D.L., Jameson J.L., editors. Harrison's principles of internal medicine. New York: McGraw-Hill; 2005. pp. 2180–2185. [Google Scholar]
  • 21.Powers A.C. Diabetes mellitus. In: Kasper D.L., Braunwald E., Fauci A.S., Houser S.L., Longo D.L., Jameson J.L., editors. Harrison's principles of internal medicine. New York: McGraw-Hill; 2005. pp. 2152–2180. [Google Scholar]
  • 22.Bower B.F., Moore R.E. Endocrine function and carbohydrate. In: McClatchey KD, editor. Clinical laboratory medicine. 2nd Ed. Philadelphia: Lippincott Williams & Wilkins; 2002. pp. 322–346. [Google Scholar]
  • 23.Cryser P.E. Glucose homeostasis and hypoglyaemia. In: Larsen PR, Kronenberg HM, Melmed S, Polonosky S, editors. William's textbook of endocrinology. Philadelphia: Saunders; 2003. pp. 1585–1618. [Google Scholar]
  • 24.Masharani U. Diabetes mellitus & hypoglycaemia. In: Tierney LM, Mcphee SJ, Papadakis MA, editors. Current Medical Diagnosis and treatment. New York: Lange Medical Books/ McGraw-Hill; 2004. pp. 1146–90. [Google Scholar]
  • 25.Brun J.F., Fedou C., Bouix O., Raynaud E., Orsetti A. Evaluation of a standardized hyperglucosidic breakfast test in postprandial reactive hypoglycaemia. Diabetologia. 1995;38(4):491–501. doi: 10.1007/BF00410289. [DOI] [PubMed] [Google Scholar]
  • 26.Shima K., Tabata M., Tanaka A., Kodaira T., Nishino T., Kumahara Y. Exaggerated response of plasma glucagons-like immunoreactivity to oral glucose in patients with reactive hypoglycaemia. Endocrinol. Jpn. 1981;28(3):249–256. doi: 10.1507/endocrj1954.28.249. [DOI] [PubMed] [Google Scholar]
  • 27.Kleinbaum J., Shamoon H. Selective counteregulatory hormone responses after glucose in man. J. Clin. Endocrinol. Metab. 1982;55(4):787–790. doi: 10.1210/jcem-55-4-787. [DOI] [PubMed] [Google Scholar]
  • 28.Vexican P., Legoff B., Cathelineau G. Insulin and cortisol secretion during OGTT in patients with reactive hypoglyccaemia with or without clinical symptoms. Horm. Metab. Res. 1983;15(9):419–421. doi: 10.1055/s-2007-1018744. [DOI] [PubMed] [Google Scholar]
  • 29.Chalew S.A., Mersey J.H., Kowarski A.A. Evidence for elevated glucose threshold in patients with impaired glucose tolerance and symptoms of hypoglycaemia during OGTT. Diabetes Care. 1990;13(5):507–512. doi: 10.2337/diacare.13.5.507. [DOI] [PubMed] [Google Scholar]
  • 30.Charles S.A., Koetter H., Hoffman S., Levin P.A., Kowarski A.A. Diagnosis of reactive hypoglycemia: Pitfalls in the use of oral glucose tolerance test. South Med. J. 1986;79(1):285–287. doi: 10.1097/00007611-198603000-00006. [DOI] [PubMed] [Google Scholar]

Articles from Indian Journal of Clinical Biochemistry are provided here courtesy of Springer

RESOURCES