Gastric emptying and hormonal changes in idiopathic reactive hypoglycaemia following a mashed potato meal
Gastric emptying and incretin hormones in idiopathic reactive hypoglycaemia following a mashed potato meal
The University of Adelaide
40 participants
Dec 13, 2021
Interventional
Conditions
Summary
In some people, blood glucose levels become low (‘hypoglycaemic’) after a meal and cause symptoms such as shakiness, sweatiness and difficulty concentrating. These symptoms can be bothersome and may be severe. Current approaches to manage this condition, so-called ‘idiopathic reactive hypoglycaemia’, are limited as we do not know what is causing the blood glucose level to drop. When food passes through the intestine, various ‘hormones’ that influence blood glucose levels enter bloodstream. While this is a useful to prevent an abnormal elevation in blood glucose after a meal, we think individuals who have low blood glucose levels after eating may have abnormally fast movement of food through the stomach and intestine leading to increased release of these ‘hormones’. This study is designed to investigate this possibility and if shown to be the case, this would provide a basis for logical, and hopefully, more effective treatment for ‘idiopathic reactive hypoglycaemia’.
Eligibility
Inclusion Criteria3
- Male and female aged 18 – 70 years, who have been diagnosed with idiopathic reactive hypoglycaemia by a primary care physician or endocrinologist
- For the control group:
- Male and female aged 18 - 70 years who do not have any hypoglycaemic disorder
Exclusion Criteria17
- History of type 1 or type 2 diabetes
- Use of any medication that may influence gastrointestinal motor function, glycaemia, body weight or appetite (e.g. glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase 4 inhibitors, opiates, levodopa, clonidine, nitrates, phosphodiesterase type 5 inhibitors, sumatriptan, metoclopramide, domperidone, prucalopride or erythromycin)
- Evidence of drug abuse, consumption of more than 20 g alcohol per day or an active smoking history
- History of chronic gastrointestinal disease (inflammatory bowel disease, coeliac disease) or prior gastrointestinal surgery (other than uncomplicated appendicectomy or cholecystectomy)
- History of epilepsy
- History of severe respiratory, cardiovascular, hepatic and/or renal disease
- Impaired renal (as assessed by calculated creatinine clearance < 90 mL/min, iron status, or liver function tests outside the following ranges:
- Alanine aminotransferase (ALT) >2x ULN
- Aspartate transaminase (AST) >2x ULN
- Alkaline phosphatase (ALP) >2x ULN
- Bilirubin >24 mmol/L
- Ferritin <15 ng/mL (Females), <30 ng/mL (Males)
- Haemoglobin <115 g/L (Females), <130 g/L (Males)
- Donation of blood within the previous 3 months
- Participation in any other research studies within the previous 3 months that requires blood sampling or exposure to radiation
- Inability to give informed consent
- Female participants who are pregnant or planning for pregnancy, or are lactating
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Interventions
Participants will be given a mashed potato meal consisting of 65g dry potato powder, 20g glucose, 20g margarine labelled with 20 MBq 99mTc-sulfur colloid and 250 ml water (1808 kJ). This meal will be consumed over 5 minutes. Following this, gastric emptying data will be acquired in 1-min frames for the first 60 minutes, followed by 3-minute frames for 240 minutes following complete consumption of the meal. The meal will be administered by a trained medical officer and will be consumed over 5 minutes, supervised by the medical officer, at the research facility. A gastric ‘region-of-interest’ will be drawn to derive emptying curves and the amount of the meal remaining in the stomach will be calculated. Caecal arrival time will be calculated as the time taken for the labelled drink to travel from the mouth to the caecum using a cobalt marker placed over the right iliac fossa. The time taken for 50% of the meal to be emptied from the stomach will be measured using scintigraphy. All components are expected to be completed within a single 6 hour session. This intervention will be applied once only per participant.
Locations(1)
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ACTRN12621001711808