Fifty-eight patients with biochemical
reactive hypoglycemia (
blood glucose 45 mg% or less after a 100 g OGTT) were tested, of whom 11 subjects were obese with normal
glucose tolerance, 9 were obese with chemical diabetes, 9 had chemical diabetes without
obesity, 6 had undergone
gastrectomy, 7 had
renal glycosuria and 16 were apparently isolated. An exaggerated
insulin response to oral
glucose was associated with
reactive hypoglycemia in the post-
gastrectomy syndrome, in normal-weight patients with chemical diabetes and 44% of the patients with the isolated syndrome. In contrast, plasma-
insulin values cannot account for the
reactive hypoglycemia observed in obese patients (with or without chemical diabetes), in subjects with renal glycosuira and in 56% of the patients with the isolated syndrome. A study of pancreatic-
glucagon secretion in a group of twelve subjects with "isolated normoinsulinemic
reactive hypoglycemia" failed to demonstrate any significant abnormality in the secretion of this
hormone during oral
glucose tolerance test or intravenous
insulin tolerance test. As suggested by Permutt et al. (1973)
biguanide therapy may be useful in the treatment of patients presenting severe and symptomatic
reactive hypoglycemia which does not respond to classical dietary management.