Acta Diabetologica

, Volume 54, Issue 2, pp 215–218 | Cite as

Reactive hypoglycaemia with seizure following intraduodenal glucose infusion in a patient with type 2 diabetes

  • Chinmay S. MaratheEmail author
  • Christopher K. Rayner
  • Karen L. Jones
  • Michael Horowitz
Case Report


It was appreciated some 60 years ago that reactive hypoglycaemia may be an ‘early’ manifestation of type 2 diabetes [1]. Postprandial reactive hypoglycaemia is, however, thought to occur rarely in type 2 diabetes; moreover, perhaps only 5 % of those affected exhibit symptoms. Gastric emptying, which exhibits a wide variability (≈1–4 kcal/min) in health, that is even greater in type 2 diabetes is now recognized to be a major determinant of the postprandial glycaemic response, particularly the initial rise in blood glucose [2]. Markedly accelerated gastric emptying of carbohydrate (≈40–100 kcal/min), in the context of altered gastrointestinal anatomy (e.g. Roux-en-Y gastric bypass or RYGB), may cause hypoglycaemia, associated with hyperinsulinaemia, possibly secondary to increased secretion of the incretin hormones (glucose-dependent insulinotropic polypeptide, or GIP, and glucagon-like peptide-1, or GLP-1). In type 2 diabetes, the insulinotropic capacity of GIP is usually...


Glucagon Gastric Emptying Reactive Hypoglycaemia Intraduodenal Infusion Frequent Blood Glucose Monitoring 
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National Health and Medical Research Council (NHMRC), Australia, Grant. KLJ is supported by a NHMRC Senior Career Development Award (NHMRC ID: 627011).

Author Contributions

All authors contributed significantly to the preparation of this paper and approved the final version. MH is the guarantor of this work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

The study on which this case report is based was approved by the Research Ethics Committee of Royal Adelaide Hospital and the participant provided his consent in writing.

Human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on the human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Informed consent was obtained from the patient for being included in the study and this case report.


  1. 1.
    Conn JW, Fajans SS, Seltzer HS (1956) Spontaneous hypoglycemia as an early manifestation of diabetes mellitus. Diabetes 5:437–442CrossRefPubMedGoogle Scholar
  2. 2.
    Marathe CS, Rayner CK, Jones KL, Horowitz M (2013) Relationships between gastric emptying, postprandial glycemia, and incretin hormones. Diabetes Care 36:1396–1405CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Nauck MA (2011) Incretin-based therapies for type 2 diabetes mellitus: properties, functions, and clinical implications. Am J Med 124:S3–18CrossRefPubMedGoogle Scholar
  4. 4.
    Marathe CS, Rayner CK, Bound M et al (2014) Small intestinal glucose exposure determines the magnitude of the incretin effect in health and type 2 diabetes. Diabetes 63:2668–2675CrossRefPubMedGoogle Scholar
  5. 5.
    Nauck MA, Vardarli I, Deacon CF, Holst JJ, Meier JJ (2011) Secretion of glucagon-like peptide-1 (GLP-1) in type 2 diabetes: what is up, what is down? Diabetologia 54:10–18. doi: 10.1007/s00125-010-1896-4 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2016

Authors and Affiliations

  • Chinmay S. Marathe
    • 1
    • 2
    Email author
  • Christopher K. Rayner
    • 1
    • 2
  • Karen L. Jones
    • 1
    • 2
  • Michael Horowitz
    • 1
    • 2
  1. 1.Discipline of Medicine, Royal Adelaide HospitalUniversity of AdelaideAdelaideAustralia
  2. 2.Centre of Research Excellence in Translating Nutritional Science to Good HealthUniversity of AdelaideAdelaideAustralia

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