Reactive hypoglycemia (RH) is the condition of postprandially (after meal) hypoglycemia occurring 2 to 5 hours after food intake that is rich in simple sugars. It can be classified as:

• Alimentary RH < 2 hours postprandially.
• Idiopathic RH at about 3 hours postprandially.
• Late RH between 3 to 5 hours postprandially.

Causes of Reactive Hypoglycemia (RH)

• Idiopathic RH: as the name suggests, we don't know. Maybe it's simply that the terrible amount of simple sugars when ingested at once will cause an abnormal surge of insulin to compensate.

• Late RH: this one's a bitch. It can be a harbinger of Diabetes Mellitus type 2 as it is caused by insulin resistance and is more common in obese people who are insulin-resistant.
One of the earliest change before type 2 diabetes is the loss of first-phase insulin release. When the first-phase insulin response decreases, first, blood glucose starts to rise after the meal, which leads to late but excessive secretion of the second-phase insulin secretion. Thus, late RH occurs.

• Alimentary RH usually occurs in gastrectomy, and dumping syndrome patients because food (especially one that is high in simple sugars) will reach the intestines more quickly than normal. With this rapid movement of food, most food does not end up getting absorbed into the blood, yet insulin will still be released in high amounts and this will cause hypoglycemia.

Reactive hypoglycemia seldom causes glucose levels to drop low enough to induce severe neuroglycopenic symptoms; therefore, a history of true loss of consciousness is highly suggestive of an etiology other than reactive hypoglycemia.

بالمناسبة، أول ما ينزل السكر رح تظهر أعراض Adrenergic. بس إذا استمر النزول لمستويات خطيرة، بوقتها رح تظهر الأعراض الـ Neuroglycopenic.

تبقى نقطة نسيتها هي الـ phases of insulin.
مباشرة بعد الأكل رح ينفرز الإنسولين على دُفعتين، الأولى تبدأ 0 إلى 5 دقائق بعد الأكل، وتنخفض نسبيًا، والثانية تبدأ بعد 20 دقيقة تقريبًا وتستمر لعدة ساعات وبيها يكون إفراز الإنسولين أعلى من الدُفعة الأُولى.

In RH of the late type (> 3 to 5 hrs), there is a loss of 1st phase insulin, and this will cause hyperglycemia which will be countered by an abnormally high release of 2nd phase insulin. This will cause hypoglycemia.

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سوالف ortho

وهاي سوالف باطنية

When you give insulin in excessive doses, you precipitate hypoglycemia in the patient, which will cause convulsions and coma. These convulsions were thought to be therapeutic in patients of psychosis. This is because in the 1930s and before, there was the faulty assumption that epileptic seizures & schizophrenic symptoms can never appear together in one patient. So if you induce convulsions in a schizophrenic patient, according to this logic, you cure them of psychosis.

The procedure involved giving the patient increasingly massive doses of insulin, which reduced the blood sugar and brought on a seizure-like state and then a comatose state. Typically, after being in the comatose state for about an hour, the procedure was terminated by administering a warm saline solution via a stomach tube or by the intravenous injection of glucose.

Complications

Features of DM type 1 vs 2

Symptoms of hyperglycemia

Lipodystrophy at Insulin injection-site

It's a complication of insulin therapy. As insulin is injected subcutaneously, it causes either one of two reactions:

• It promotes lipid formation & adipose tissue hypertrophy at the site of injection. This will cause a "lump" of fat there which can resemble a benign tumor in appearance. This condition is called Lipohypertrophy (lipo-hyper-trophy).

• It causes an immune reaction which results in the production of insulin antibodies that will suppress insulin activity especially at the site of injection (where its concentration is high). This will cause down-regulation of fat production & atrophy of adipose tissue, therefore it's called Lipoatrophy. This condition was more common in the days of bovine & porcine insulin (insulin extracted from cows and pigs). Nowadays we use recombinant human insulin, which is much less likely to cause an immune reaction.