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Interstitial glucose profile associated with symptoms attributed to hypoglycemia by otherwise healthy women^1,2,3

¹ From the University of Nottingham, School of Biomedical Sciences, Queen's Medical Centre, Nottingham, United Kingdom (EJS and IAM), and the Division of Nutritional Sciences, Sutton Bonington campus, Loughborough, United Kingdom

Background:Reports of postprandial symptoms attributed to hypoglycemia by otherwise healthy individuals appear to be relatively common in UK women. Whether these symptoms are related to blood glucose is a contentious issue, which periodic ambulatory blood glucose measurement has failed to resolve.

Objective:The authors investigated, using continuous glucose monitoring technology, whether postprandial symptoms are associated with interstitial glucose concentrations (IG) in the hypoglycemic range or with a previous fall in IG.

Design:Thirty healthy nonobese women (age 20-48 y) who reported symptoms attributable to hypoglycemia and 20 nonsymptomatic controls wore a subcutaneous probe in abdominal fat for 4-7 d (median: 5 d) and kept a diet and activity diary during this time.

Results:Twenty women reported postprandial symptoms; 41 episodes were recorded. When symptomatic, IG was 3.3 mmol/L in 5% of cases. A significant fall in IG over the preceding 60 min was observed before autonomic symptoms (P < 0.005). The proportion of total energy intake derived from dietary fat in the symptomatic group was higher than that in the controls (P < 0.05). The proportion of total sugars was similar between groups; however, the meal preceding symptoms had a higher percentage of energy derived from total sugars when compared with the individuals' diet over the study period (P < 0.05).

Conclusions:Most symptoms attributable to hypoglycemia were not associated with an IG concentration in the hypoglycemic range. A previous fall in IG may be implicated in the etiology of autonomic symptoms, with the consumption of meals high in sugars potentially playing a role in symptom initiation.

Key Words: Reactive hypoglycemia • women • continuous glucose monitoring • United Kingdom