Does Reactive Hypoglycemia During The 100 G Oral Glucose Tolerance Test Adversely Affect Perinatal Outcomes? | Delibas | Ginekologia Polska
Does reactive hypoglycemia during the 100 g oral glucose tolerance test adversely affect perinatal outcomes? Ilhan Bahri Delibas, Sema Tanriverdi, Bulent Cakmak Objectives: To determine whether pregnant women who have reactive hypoglycemia during the 100 g oral glucose tolerance test (OGTT) are at an increased risk of poor pregnancy outcomes. Material and methods: We retrospectively analyzed perinatal data from 413 women who underwent a 3 h OGTT at 2428 weeks of gestation and gave birth in our clinics between January 2012 and December 2014. Results: According to OGTT results, the majority of the subjects were normoglycemic (n = 316, 76.5%), while 49 (11.9%) were diagnosed with gestational diabetes, and 33 (8.0%) had single high glucose values. Reactive hypoglycemia was detected in only 15 patients (3.6%). The mean age of the women in the reactive hypoglycemia group was significantly lower than that of the women in the gestational diabetes and single high glucose value groups (26.4 4.4 years, 31.4 5.4 years, and 31.8 4.3 years, respectively; p < 0.05). The newborns of the women in the reactive hypoglycemia group had higher rates of APGAR scores < 7, increased admission to the neonatal intensive care unit (NICU), and lower birth weights compared with the other groups (p < 0.001, p < 0.001, and p = 0.009, respectively). Conclusion: Reactive hypoglycemia during the 3 h 100 g OGTT is significantly associated with low APGAR scores, low birth weights, and prenatal admission to the NICU. Therefore, pregnant women who develop hypoglycemia during the 100 g OGTT performed at 2428 weeks of gestation should receive attentive follow-up care to decrease the possibility of adverse perinatal outcomes. Objectives: To determine whether pregnant women who have reactive hypoglycemia during Continue reading >>
Does Hypoglycemia Following A Glucose Challenge Test Identify A High Risk Pregnancy?
Does hypoglycemia following a glucose challenge test identify a high risk pregnancy? 1Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, Portsmouth, VA, USA 2School of Women's and Infants' Health, University of Western Australia, Perth, Australia 3Department of Obstetrics and Gynecology, Aurora Health Care, West Allis, WI, USA 4Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS, USA Suzanne K Pugh: [email protected] ; Dorota A Doherty: ua.ude.awu.nygsbo@ytrehodd ; Everett F Magann: [email protected] ; Suneet P Chauhan: [email protected] ; James B Hill: [email protected] ; John C Morrison: ude.demsmu.nyg-bo@nosirromj Received 2008 Nov 24; Accepted 2009 Jul 14. Copyright 2009 Pugh et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. An association between maternal hypoglycemia during pregnancy with fetal growth restriction and overall perinatal mortality has been reported. In a retrospective pilot study we found that hypoglycemia was linked with a greater number of special care/neonatal intensive care unit admissions and approached significance in the number of women who developed preeclampsia. That study was limited by its retrospective design, a narrow patient population and the inability to perform multivariate analysis because of the limitations in the data points collected. This study was undertaken to compare the perinatal outcome in pregnancies with hyoglycemia following a glucose challenge test (GCT) Continue reading >>
Testing For Hypoglycemia And How Your Doctor Can Help
The correct test for Reactive Hypoglycemia is a G.T.T. The test should be ordered by the doctor as follows: G.T.T. – 4 hours. All 1/2 hourly readings. No special diet prior. The Glucose Tolerance Test is the classical test used in diagnosing Diabetes. The Diabetic test is a 2 hour G.T.T. with just 3 readings, the fasting, the 1 hour and the 2 hour. This test is not correct for testing Functional or Reactive Hypoglycemia. With Hypoglycemia one is interested in the full reactions to a sugar load. In both cases a 75gram load of glucose is given to the patient after having collected blood for the fasting level. With Reactive Hypoglycemia the emphasis in on the word “Reactive”- one is looking for the sugar reactive phenomenon in which the blood sugar either drops suddenly or falls very low. Part of diagnostic criteria for Hypoglycemia is the rate of fall of blood sugars, hence the relationship between consecutive readings is very important. Sudden drops in blood glucose will usually trigger an adrenaline response and subsequently adrenaline symptoms such as nervousness, shakiness, dry mouth, irritability, agitation, neck stiffness and sometimes palpitations or a racy heart. With Reactive Hypoglycemia one is also seeking to ascertain how low the blood sugar may go as this in fact is one of the measures of severity. The brain is dependent on blood glucose as it’s only fuel supply under normal circumstances. When the blood glucose falls below a certain level, usually 3.6mm/L, there is a lack of available fuel to the brain and symptoms of brain starvation will occur – these include tiredness, moodiness, depression, forgetfulness, poor concentration and cloudy headedness. The purpose of the G.T.T is to clarify how well one tolerates glucose and by doing it properly one Continue reading >>
Insulinomas May Present With Normoglycemia After Prolonged Fasting But Glucose-stimulated Hypoglycemia
Insulinomas May Present with Normoglycemia after Prolonged Fasting but Glucose-Stimulated Hypoglycemia Department of Medicine (P.K., P.P.), Great Western Hospital, Swindon SN1 4JU, United Kingdom Search for other works by this author on: Department of Medicine (P.K., P.P.), Great Western Hospital, Swindon SN1 4JU, United Kingdom Search for other works by this author on: North Cumbria Acute Hospitals National Health Service (NHS) Trust (S.S.), Whitehaven CA28 8JG, United Kingdom Search for other works by this author on: Department of Medicine (P.K., P.P.), Great Western Hospital, Swindon SN1 4JU, United Kingdom Search for other works by this author on: Academic Radiology (R.H.R.), Barts and the London NHS Trust, London EC1A 7BE, United Kingdom Search for other works by this author on: Departments of Endocrinology (A.B.G.), Hepatobiliary Surgery (S.B.) London EC1A 7BE, United Kingdom Address all correspondence and requests for reprints to: Prof. A. B. Grossman, Department of Endocrinology, St. Bartholomews Hospital, London EC1A 7BE, United Kingdom. Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, Volume 91, Issue 12, 1 December 2006, Pages 47334736, Partha Kar, Paul Price, Stewart Sawers, Satya Bhattacharya, Rodney H. Reznek, Ashley B. Grossman; Insulinomas May Present with Normoglycemia after Prolonged Fasting but Glucose-Stimulated Hypoglycemia, The Journal of Clinical Endocrinology & Metabolism, Volume 91, Issue 12, 1 December 2006, Pages 47334736, Background: Insulinomas are rare but are the most common cause of hyperinsulinemic hypoglycemia in the adult population. Diagnosis of this pathology relies on clinical features along with laboratory tests and imaging investigations to aid in localization. One of the most robust s Continue reading >>
Postprandial Reactive Hypoglycaemia: Varying Presentation Patterns On Extended Glucose Tolerance Tests And Possible Therapeutic Approaches
Copyright © 2013 Kevin Stuart et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Reactive hypoglycemia is a state characterised by sympathetic or neuroglycopenic symptoms associated with hypoglycaemia in the postprandial state resulting in considerable distress to the patient. It is our practice to carry out either extended glucose tolerance tests (eGTTs) or mixed meal tests in these patients. We describe two patients who experienced hypoglycaemic symptoms early and late during eGTT. The patient who experienced symptoms early, in contrast to the patient who presented with late symptoms, did not possess any characteristics of the metabolic syndrome. Based on clinical symptoms, glucose, insulin, and free fatty acid (FFA) levels, we speculate on possible mechanisms that may have accounted for each of their presentation patterns. We then discuss low glycaemic index diet which will be the mainstay of management. 1. Introduction Reactive hypoglycaemia is often considered in patients developing sympathetic or neuroglycopenic symptoms in the postprandial state. Prior to this diagnosis being reached, it is essential that hypoglycaemia must be demonstrated to be associated with the symptoms (It has been suggested that demonstration of hypoglycaemia (glucose lower than 3.9 mmol/L or 70 mg/dL) while symptomatic and alleviation of symptoms following normalisation of glucose levels should replace the extended gluces tolerance test (eGTT). However, this can pose practical problems as patients would need laboratory bloods to be carried out when symptomatic for a reliable diagnosis. In view of this, it has be Continue reading >>
- Postprandial Blood Glucose Is a Stronger Predictor of Cardiovascular Events Than Fasting Blood Glucose in Type 2 Diabetes Mellitus, Particularly in Women: Lessons from the San Luigi Gonzaga Diabetes Study
- Diabetes can lead to hypoglycaemia - know the symptoms and act promptly
- New approaches to Diabetes management could transform healthcare in Saudi Arabia
Diagnosing Diabetes
In diagnosing diabetes, physicians primarily depend upon the results of specific glucose tests. However, test results are just part of the information that goes into the diagnosis of type 1 or type 2 diabetes. Doctors also take into account your physical exam, presence or absence of symptoms, and medical history. Some people who are significantly ill will have transient problems with elevated blood sugars, which will then return to normal after the illness has resolved. Also, some medications may alter your blood glucose levels (most commonly steroids and certain diuretics, such as water pills). The 2 main tests used to measure the presence of blood sugar problems are the direct measurement of glucose levels in the blood during an overnight fast and measurement of the body's ability to appropriately handle the excess sugar presented after drinking a high glucose drink. Fasting Blood Glucose (Blood Sugar) Level A value above 126 mg/dL on at least 2 occasions typically means a person has diabetes. The Oral Glucose Tolerance Test An oral glucose tolerance test is one that can be performed in a doctor's office or a lab. The person being tested starts the test in a fasting state (having no food or drink except water for at least 10 hours but not greater than 16 hours). An initial blood sugar is drawn and then the person is given a "glucola" bottle with a high amount of sugar in it (75 grams of glucose or 100 grams for pregnant women). The person then has their blood tested again 30 minutes, 1 hour, 2 hours, and 3 hours after drinking the high glucose drink. For the test to give reliable results, you must be in good health (not have any other illnesses, not even a cold). Also, you should be normally active (for example, not lying down or confined to a bed like a patient in a Continue reading >>
Reactive Hypoglycemia - Can Anyone Help Please?
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Reactive Hypoglycemia - Can Anyone Help Please? I'm new here so sorry if I am posting in the worng place. I am bit confused over a recent diagnoses and wondered if anyone might be able to point me in the right direction? I know any advice ofered will be of an experiance nature and not medical, but it may just help me out. About 20 months ago I was admitted to hospital with a suspected heart attack. After investigation it was decided I was not cardiac, but needed to see the Endocrine team. After many months of tests for just about everything from Thyroid to Carcenoid, I was told the results of a fasting blood test revealed Reactive Hypoglycemia. My results on fasting were 13.5, followed by 4.5 after being given Glucose and then droping out an hour later to 3.5. For the past 2 weeks I have had a blood monitor, given to me by the Diabetic Nurse. My readings are always with in the normal range or very close, with the lowest ever being 4.5. My average over 2 weeks is 6.0. However I am still experiancing, very bad headaches, which I was told was because the sugar goes to my brain! My vison is all over the place and I am very tired and fed up. I think my blood sugar levels are good, so am not sure if this is normal? Can anyone suggest anything? or has anyone had experiance of this. I don't even know if Hypoglycemia is Diabetes..... Reactive hypoglycemia, or postprandial hypoglycemia, is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring within 4 hours[1] after a high carbohydrate meal (or oral glucose load) in people who do not have diabetes. It is thought to represent a consequence of excessive insulin release triggered by th Continue reading >>
What Is The Glucose Tolerance Test?
So you think you may have hypoglycemia. You have all the symptoms. After discussing it with your physician, he agrees to give you a glucose tolerance test (GTT) to confirm the diagnosis. A test for three or four hours is requested when diabetes is suspected, but a six-hour glucose tolerance test is, by far, the most reliable method to detect low blood sugar. The HSF has always recommended that you settle for nothing less than the six-hour GTT. However, for a different perspective please see the section titled “Ask The Experts” for Dr. Baird’s response to the question of whether a patient should take a glucose tolerance test to confirm hypoglycemia. The night before having the GTT, you will be asked to fast after your evening meal. You are to eat or drink nothing until the time of the test. When you arrive at the doctor’s office or laboratory, still fasting, a tube of blood will be drawn and you will be asked to give a urine specimen. Then you will be given a very sweet beverage called “Glucola” to drink. This drink contains a measured amount of glucose. Your blood will be drawn in 30 minutes and once again in one hour after drinking the Glucola. For each hour after that, you will give a blood sample until five or six hours have passed. A urine specimen is given each time your blood is drawn. Each tube of blood and each urine specimen are tested to determine the amount of glucose it contains. When the report is sent to your doctor, he or she will be looking for glucose levels above or below normal at any time during the test. During the test, you may start to sweat, get dizzy, weak or confused. If you experience these symptoms to the point of being extremely uncomfortable for you get a headache or your heart starts beating quickly, ask the doctor’s staff to Continue reading >>
Revisiting The Oral Glucose Tolerance Test For The Diagnosis Of Hypoglycemia In Adults: What Can We Learn?
Idiopathic reactive hypoglycemia (IRH) is poorly understood. Some believe that overconsumption of refined carbohydrates induces insulin release, a drop in blood glucose (BG), and a surge in counter-regulatory hormones. The objective of this retrospective study was the relationship between glucose metabolism, using a 5-hour oral glucose tolerance test (OGTT), and anthropometry, medical history and counter-regulatory hormones. To access this article, please choose from the options below Continue reading >>
Reactive Hypoglycemia?
See active discussions on October 2010 Babies So, I failed my one hour glucose test at 143. Took my 3 hour test yesterday and the report says it is consistent with reactive hypoglycemia. My 3 hour glucose was 45! Anyone have any experience with this? I haven't heard from my doctor yet, but was curious if I'll still be on a special diet. @opalharmony I had this same problem in high school. I wasn't pregnant at the time so I don't know how much help I am going to be. I was having trouble while performing in sports so they did the 3 hour glucose tolerance test. My blood sugar shot up above normal then it dropped below normal. I was basically told to keep some form of food like candy with me at all times and to eat some every couple of hours. I still do it now that I'm pregnant. I haven't been told the results of my 1 hour test yet so I'm wondering how it is going to play out during this pregnancy. Hope this helps a little. I've been hypoglycemic my whole life. If I feel crappy I usually eat something and feel better. That's about it. This happened with my first 3 hour test. When I left my sugar was only 35 and I started sweating and shaking. They didn't changed my diet but told me to go ahead and eat whatever I wanted. @Rmgodin Same with me, I actually get a really bad headache if I don't eat every few hours and last night was so preoccupied that I didn't realise until I had the headache that I needed to eat. Dh ordered pizza and about 3 to 4 slices of pizza, a glass of pepsi and an hour later I was feeling better and wasn't so bitchy. :D it sucks and I have my dr's appointment today and will find out if I passed my 1 hour gd test today so am hoping for some good news. Low bs is in my mind easier to manage than high bs. @opalharmony I have had problems with hypoglycemia m Continue reading >>
Hypoglycemia During The 100-g Oral Glucose Tolerance Test: Incidence And Perinatal Significance
The 3-hour, 100-g oral glucose tolerance test (GTT) is the accepted method for diagnosing gestational diabetes mellitus (GDM) during pregnancy. 1,2 It is a common knowledge among health caregivers that a significant number of women experience symptoms of hypoglycemia during the test, including tachycardia, faintness, nausea, and perspiration. In some, very low blood glucose levels may be detected concomitantly. The finding of low blood glucose levels or symptomatic hypoglycemia during the test may cause anxiety and apprehension for both the woman and the medical personnel. However, we did not find in the literature or among the experts who deal with diabetes answers to 2 simple questions: 1) What is the incidence of hypoglycemia during the oral GTT? and 2) Do women who react with hypoglycemia have different perinatal outcome than women without hypoglycemia? We hypothesized that women who react with hypoglycemia make up a unique group whose physiological characteristics may be different from women without hypoglycemia, and therefore their perinatal outcome may be different. There is no clear cutoff blood glucose level for experiencing hypoglycemic symptoms; some patients may exhibit a hypoglycemic reaction at a normal glucose range whereas others may be unaware of hypoglycemia even at very low blood glucose concentrations. 3,4 In various reports, 50 mg/dL was considered to be a suitable glucose concentration for the diagnosis of hypoglycemia. 3,57 The goal of the present study was to estimate the incidence of hypoglycemia (plasma glucose levels 50 mg/dL) during the 100-g oral GTT and to report its possible effect on perinatal outcome. We analyzed the perinatal data of all women who underwent the 3-hour oral GTT and delivered in our institution between December 1998 and Continue reading >>
Glucose Tolerance Test
The glucose tolerance test is a medical test in which glucose is given and blood samples taken afterward to determine how quickly it is cleared from the blood.[1] The test is usually used to test for diabetes, insulin resistance, impaired beta cell function,[2] and sometimes reactive hypoglycemia and acromegaly, or rarer disorders of carbohydrate metabolism. In the most commonly performed version of the test, an oral glucose tolerance test (OGTT), a standard dose of glucose is ingested by mouth and blood levels are checked two hours later.[3] Many variations of the GTT have been devised over the years for various purposes, with different standard doses of glucose, different routes of administration, different intervals and durations of sampling, and various substances measured in addition to blood glucose. History[edit] The glucose tolerance test was first described in 1923 by Jerome W. Conn.[4] The test was based on the previous work in 1913 by A. T. B. Jacobson in determining that carbohydrate ingestion results in blood glucose fluctuations,[5] and the premise (named the Staub-Traugott Phenomenon after its first observers H. Staub in 1921 and K. Traugott in 1922) that a normal patient fed glucose will rapidly return to normal levels of blood glucose after an initial spike, and will see improved reaction to subsequent glucose feedings.[6][7] Testing[edit] Since the 1970s, the World Health Organization and other organizations interested in diabetes agreed on a standard dose and duration. Preparation[edit] The patient is instructed not to restrict carbohydrate intake in the days or weeks before the test.[citation needed] The test should not be done during an illness, as results may not reflect the patient's glucose metabolism when healthy. A full adult dose should not be Continue reading >>
Reactive Hypoglycemia – A Lurking Fear
Reactive Hypoglycemia……. A lurking fear Reactive hypoglycemia or its synonym Post prandial hypoglycemia in otherwise normoglycemic individuals, though not taken too well, is not an unexpected finding in routine Blood Glucose Estimation in Clinical Labs of repute. Though diagnostic labs always have a relook in these reports of comparative low post prandial glucose levels before releasing it to clients or clinicians but then the labs are mentally prepared to answer volley of queries not only from patients/individuals but also from ambitious medical practitioners. Maintenance of plasma glucose concentration within narrow bounds is essential for health. Lower levels of blood glucose relates to a pathological condition, popularly termed as hypoglycemia, which is a dangerous condition as brain for which primary source of energy substrate is only glucose tends to be vulnerable because it can not utilize circulating fatty acids as energy source as evident in other tissues. Hypoglycemia can be classified as Postprandial (reactive ) or fasting. Low glucose levels occurring in response to and as a follow up after meals is what we call it Reactive(PP) hypoglycemia. Levels of PP glucose falling below fasting could be marginal or more but than any levels falling below 2.5 mmol/litre (45 mg/dl) can lead to adverse effects producing recognizable symptoms which may be autonomic or neuroglycopenic but these are unlikely to surface on levels above 2.8 mmol/l (50mg/dl). It is commonly thought that fasting hypoglycemia is a serious condition with most likely etiopathology of insulinoma whereas reactive hypoglycemia is invariably a benign disorder. However yet another type of hypoglycemia is drug induced which can be encountered in patients of diabetes mellitus who are either on insulin Continue reading >>
Hypoglycemic And Failed Glucose Test - Pregnancy-info
So, I've never been officially "diagnosed" with hypoglycemia but I have the classic symptoms and respond well to the recommended diet for hypoglycemia. I just got the call from my nurse saying I failed the initial glucose test (by only two points at 141) and now have to do the three hour test. What I'm worried about is the way hypoglycemia works is blood sugar runs low and then when you eat it jumps up in an "abreaction" to the food. I'm worried that I'm going to get labeled with gestational diabetes when it may be due to this. Any suggestions or anyone that is more knowledgeable about how all of this works? Very frustrated right now since they just called today and want me to get the three hour test done before my appointment on Wednesday. Does your dr know you're hypoglycemic? I think actually a lot of people get hypoglycemic while pregnant or at least their blood sugar drops really low really quickly (mine does). You should ask your dr if this could be a problem. This is my third pregnancy and with my first two I failed the initial test- the first pregnancy just by a couple points like you and the second test I was borderline at the top but I ended up pa__sing both three hr tests. The test is three hrs (as i'm sure you know) and you can fail one of the hours but have to pa__s the others to pa__s the test. The nurse is supposed to be calling me back today so hopefully I'll be able to talk to her about it. I've already pre-registered for the three hour test so I'll get to do it Monday morning. I've dealt with hypoglycemia since around age 13 (now 24) and actually it's not been as bad during the pregnancy. Anyway, I really think that it could be throwing off the results and I realized later that I ate yogurt right before I drank the stuff for the one hour test which wa Continue reading >>
Hypoglycemia During The 100-g Oral Glucose Tolerance Test: Incidence Andperinatal Significance.
1. Obstet Gynecol. 2005 Jun;105(6):1424-8. Hypoglycemia during the 100-g oral glucose tolerance test: incidence andperinatal significance. Weissman A(1), Solt I, Zloczower M, Jakobi P. (1)Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel. [email protected] OBJECTIVE: To estimate and report the incidence and perinatal significance ofhypoglycemia during the 100-g oral glucose tolerance test in pregnant women.METHODS: Over a 3-year period, we analyzed the incidence and perinatal outcome ofpregnant women who experienced hypoglycemia, defined as a plasma glucose level of50 mg/dL or less while undergoing the 100-g oral glucose tolerance test. Thestudy group included women who delivered singletons at term. Women who underwent the 100-g oral glucose tolerance test during the same period and had nohypoglycemia served as the control group.RESULTS: A total of 805 women were included in the study, which comprised 51women (6.3%) who experienced hypoglycemia during the test and 754 women in thecontrol group. Gestational diabetes mellitus was diagnosed in 5/51 (9.8%) womenin the study group, compared with 216/754 (28.6%) women in the control group (P <.03), and the neonates born to these women had significantly lower birth weights.CONCLUSION: The incidence of reactive hypoglycemia during the 100-g oral glucose tolerance test in our population is 6.3%. Women who experience hypoglycemiaduring the test have a significantly lower incidence of gestational diabetes and neonatal birth weights. Continue reading >>
