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Hypoglycaemia and gastric emptying
Author(s) -
Marathe Chinmay S.,
Marathe Jessica A.,
Rayner Christopher K.,
Kar Palash,
Jones Karen L.,
Horowitz Michael
Publication year - 2019
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13570
Subject(s) - gastric emptying , postprandial , gastroparesis , medicine , insulin , diabetes mellitus , gastroenterology , type 2 diabetes , endocrinology , stomach
Hypoglycaemia is arguably the most important complication of insulin therapy in type 1 and type 2 diabetes. Counter‐regulation of hypoglycaemia is dependent on autonomic function and frequent hypoglycaemia may lead to reductions in both autonomic warning signals and the catecholamine response, the so‐called “impaired awareness of hypoglycaemia”. It is now appreciated that gastric emptying is a major determinant of the glycaemic response to carbohydrate‐containing meals in both health and diabetes, that disordered (especially delayed) gastric emptying occurs frequently in diabetes, and that acute hypoglycaemia accelerates gastric emptying substantially. However, the potential relevance of gastric emptying to the predisposition to, and counter‐regulation of, hypoglycaemia has received little attention. In insulin‐treated patients, the rate of gastric emptying influences the timing of the postprandial insulin requirement, and gastroparesis is likely to predispose to postprandial hypoglycaemia. Conversely, the marked acceleration of gastric emptying induced by hypoglycaemia probably represents an important counter‐regulatory response to increase the rate of carbohydrate absorption. This review summarizes the current knowledge of the inter‐relationships between hypoglycaemia and gastric emptying, with a focus on clinical implications.