This article is more than 5 years old. Information may no longer be current.
Fructose poses little risk for patients with postgastric bypass hypoglycemia
Little risk for hypoglycemia is found among adults with postgastric bypass hyperinsulinemic hypoglycemia after consumption of a meal sweetened with fructose, according to recent study findings published in The Journal of Clinical Endocrinology & Metabolism.
Researchers also found that hypoglycemia was not prevented by treatment with rapid-acting insulin before a high-carbohydrate meal.
Anne E. Bantle, MD, of the University of Minnesota, and colleagues evaluated 10 patients (nine women; mean age, 48 years; mean weight, 78.4 kg; mean BMI, 28.2 kg/m2) with postgastric bypass hyperinsulinemic hypoglycemia to determine whether rapid-acting insulin before a high-carbohydrate meal or replacement of other carbohydrates with fructose in the meal could prevent hypoglycemia. Hypoglycemia symptoms started a mean 2.5 years after bariatric surgery.
Researchers compared the effects of a high-carbohydrate meal with pre-meal saline injection (control), a high-carbohydrate meal with pre-meal insulin injection and a high-fructose meal with total carbohydrate content similar to the control to determine the risk for hypoglycemia.
No differences in fasting values were found among the three meal types.
After the control meal, peak plasma glucose was 173 mg/dL and serum insulin was 134 mU/L. The mean postprandial plasma glucose was 44 mg/dL and came 132 minutes after starting the meal. A plasma glucose nadir of less than 60 mg/dL was found in eight participants, and five participants had a nadir of less than 40 mg/dL.
Postprandial hyperglycemia, hyperinsulinemia and subsequent hypoglycemia were not prevented by insulin pretreatment. After the pretreatment insulin injection meal, mean peak postprandial glucose was 182 mg/dL and serum insulin was 148 mU/L, which were not significantly different from the control meal values. All participants reached mean plasma glucose nadir of less than 60 mg/dL (mean, 34 mg/dL), which was significantly lower than following the control meal.
After the fructose meal, the mean peak postprandial plasma glucose was 117 mg/dL and mean peak postprandial serum insulin was 45 mU/L, which were significantly lower than following the control meal.
“In summary, our study demonstrated that fructose is a dietary carbohydrate which people with postgastric bypass hypoglycemia can consume with little risk of subsequent hypoglycemia,” the researchers wrote. “We were not able to demonstrate that rapid-acting insulin treatment before a carbohydrate-containing meal prevented hypoglycemia, but it is possible that, with different timing or a different dose of insulin, hypoglycemia might be prevented.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.