Talk:Idiopathic postprandial syndrome

real?

real?

PMID 6265488 PMID 6690833 PMID 7227659 Comparison of oral glucose tolerance tests and mixed meals in patients with apparent idiopathic postabsorptive hypoglycemia: absence of hypoglycemia after meals. AU - Charles MA; Hofeldt F; Shackelford A; Waldeck N; Dodson LE Jr; Bunker D; Coggins JT; Eichner H SO - Diabetes 1981 Jun;30(6):465-70.

The relationship between symptoms of idiopathic postabsorptive hypoglycemia and glucose homeostasis was evaluated by giving oral glucose tolerance tests (OGTT) and mixed meals to 18 patients and 16 controls. Chemical hypoglycemia after OGTT occurred as often in patients referred because of possible hypoglycemia symptoms, 18 out of 80 (23%), as in controls, 4 out of 16 (25%). After glucose, patients showed both clinical and chemical hypoglycemia (mean +/- SE plasma glucose, 48 +/- 3 mg/dl), but insulin, glucagon, and growth hormone responses were similar to controls. After mixed meals, no chemical hypoglycemia occurred in patients (mean plasma glucose, 79 +/- 3 mg/dl), yet 14 out of 18 (78%) had symptoms and/or signs consistent with hypoglycemia. No abnormality of glucose homeostasis was observed after meals that could account for symptoms or signs experienced by patients with idiopathic postabsorptive hypoglycemia. Since factors other than hypoglycemia appear to be involved, the disorder should be termed the idiopathic postprandial syndrome to avoid the connotation of chemical hypoglycemia.

Adrenergic postprandial syndrome

Although they are similar in symptoms, adrenergic postprandial syndrome is not a kind of reactive hypoglycemia (there is not hypoglycemia at the time of the symptoms), but a postprandial syndrome. So, in my opinion, it's better to put some information about in RH page and in IPS page too, isn't it?

--84.222.152.153 13:50, 4 July 2007 (UTC)

In summary, you have repeatedly inserted two assertions, both of which are false and unsupported by your references. You said:

1. symptoms can be triggered by hyperinsulinism (excess of insulin) without hypoglycemia (low glucose)

2. a diagnostic test for this kind of syndromes should include also an insulin curve.

Assertion 1 is false. There is no causal relationship of high insulin and IPS claimed or demonstrated in either paper nor in any other high-quality medical research I know of. These authors certainly would not agree with your claim. Assertion 2 is also false. Higher insulin levels are characteristic of reduced insulin sensitivity of any cause, and neither of these papers demonstrate that measuring insulin levels in an OGTT helps make a diagnosis of IPS. In fact, both can be construed as supporting (Brun explicitly, Berlin implicitly) that an OGTT has no value in this type of work-up.

I am once again removing them but will add a description of the Berlin paper and will format it correctly. I will also format the Brun paper for you here if you would like to put it in the reactive hypoglycemia article. I assume your contributions represent a good faith misunderstanding of the papers and would be happy to discuss further with you if you would like further elaboration, but if you simply re-insert without responding to this you have crossed the line into being a destructive nuisance. Give me an hour or so to redescribe the Berlin paper and re-format the reference. alteripse 15:08, 4 July 2007 (UTC)

First, I apologize for the poor english I could use in this discussion, I am from Italy and have not a complete knowledge of english language. You're right about the hyperinsulinism, there's no proven cause-effect beetwen it and IPS. In consequence, also "assertion 2" is almost partially wrong. Pragmatically, a fact is that rarely a lab would check if epinephrine and noradrenaline of the patients are right (well, isoproterenol test is not a very common test, is it?). Insulin is easier to check, and often, in OGTT (i.e. for diabetes mellitus screening), insulinic and glycemic curve are checked togheter. But probably there's no matter to do it for recognizing an IPS. So, I admit the boldness and the non-scientific pattern of "assertion 1 and 2". Oh, about the suitablity of the OGTT: you surely have read about the breakfast test; insulin could be checked during it, but of course in most cases there's no need to do it. Sorry the mistakes (about the article, and the grammar ones) Oh, and congratulations for your contributes in wikipedia.84.222.154.122 02:30, 5 July 2007 (UTC)

Well, deleted the wrong line about hyperinsulinism in the article.84.222.154.122 02:33, 5 July 2007 (UTC)

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I don't intend to write anywhere on this article, however, I do happen to have this..."syndrome." I am also not about to attempt to correct any of the above medical studies with personal experience, partly because it seems right-on, and partly because over the course of my life I have watched non-insulin related hypoglycemia go from being considered completely fictitious, to some rouge form diabetes, to a complete mental disorder confusable with schizophrenia, to only recently, finally, a possible malfunction/advantageous use of enzymes released by the adrenal gland. I do however, wish to state that while the above study does a good job of making those two points seem dismissed, for the sake of anyone else reading this article: (In my experience)

Point 1: Excess insulin may still give you hypoglycemic shock. The above article was only attempting to state that this is not likely the cause for why one experiences these symptoms, not necessarily that injecting yourself with insulin won't affect you.

Point 2: A diagnostic insulin test is not necessary for this form of test, but for the sake of the individual, should likely still be given. Not all individuals with this...syndrome...experience higher levels of insulin, I for one am smack dab normal according to the American Diabetes Association. However, this form of hypoglycemia, somehow or another, tends to be related to Diabetes, so checking one's insulin levels, given the opportunity, is never a bad idea justto be safe.

If anyone happens to have any questions, feel free to email me at exp103@gmail.com. I am not a doctor, and will not respond as such, but I have had this my entire life, so if you would like to email me for non-technical questions, feel free. -Sept 24th, 2008-

Prognosis

I wonder how many of these people turn up with insulin resistance or related problems after a couple of years. WhatamIdoing (talk) 06:25, 29 January 2008 (UTC)

- So maybe about a quarter of my family has a variant of this "syndrome," and so far, none of them have had any insulin related problems, regardless of age. That said, another fragment of my family happens to have diabetes, which most certainly is an insulin related problem. Strangely, there has been no overlap of diabetes, or any other insulin related issue, with what you all are calling IPS, in any one individual, thus far. Here's to hoping it stays that way.- Sept 24, 2008 -

Should Be Added

I need to go study for a test, and hence do have the time or wiki know-how to update this page to all of your likings', however this page should include the full list of side effects from hypoglycemia, not simply the few mentioned already on the page. If nothing else _include_headaches_ as they are often the symptom people find hardest to ignore, while simultaneously being extremely common. Also, Hypoglycemic Fatigue should be mentioned - ie, the fact that the symptoms any particular individual with hypoglycemia has can and often do change over time. Self testing methods should probably also be put up here. The most obvious is if you feel nauseas, tired, sick and have headaches if you don't eat every few hours, and magically everything then becomes better, consistently, after eating a small (somewhat healthy, or sugary) snack, you may have a form of hypoglycemia. If you find yourself experiencing any of the symptoms to some degree after not eating for a set number of hours (2.5 to 3), you may have hypoglycemia. Unfortunately, as there is no true common test for IPS that I know of (we've already stated insulin checks aren't effective) most unknowing individuals with IPS have been raised to have the symptoms treated, without ever addressing the underlying issue. Provided the individual does in fact eat regularly, learning to control mood swings, stifle hunger, etc will take care of a good number of the symptoms. This wouldn't be an issue except for the fact that brainpower greatly decreases during these periods. The ability to learn while "sugar low" is often stymied, mental power tends to fall sharply, quality of work drops, tendency for accidents to occur rises, etc. As this is also a syndrome of perception, it is very easy for people who have been raised to believe they are normal, and just work on suppressing symptoms to also convince themselves that the previous examples (quality of work, inability to learn effectively) are not actually occurring, or are not, at least, a result of not eating. As a result, a number of simple self-tests should be mentioned, for those who think they may have this. Also, the 2.5 to 3 hour number previously mentioned should mentioned in the article, as it seems to hold true (at least in my experience) for most hypoglycemics, and, more importantly, once an individual sees the same symptoms occurring 2.5 to 3 hours after eating, again and again, it becomes easier to accept, and more importantly, easier to identify in small children form whom all rates of hypoglycemia are higher than the general population. Perhaps we could also add a section mentioning the positive sides of IPS? Often individuals who experience low blood sugar and/or the related symptoms often report being more artistic, in touch with feelings, artisan, at peace, etc when slightly sugar low. Indeed, just as individuals with Synesthesia often claim to like and/or be thankful for their "disorder," I have heard similar statements about IPS. I for one consider it a bit of a blessing for a long list of reasons. -Sept 24, 2008- —Preceding unsigned comment added by 69.202.65.199 (talk) 20:21, 24 September 2008 (UTC)

Well my friend, I have what I believe is this syndrome for almost six years, and I can say, with all due respect, that it's not a blessing. That being said, I think you are absolutely right that people with this condition are stigmatized. I feel that way. I went to a doctor and specialist with an attempt to have this diagnosed only to be told that it is not real because I do not have the low blood sugar of hypoglycemia. My mood, cognitive ability and performance greatly diminishes when I am having symptoms, and this negatively affects my ability to function. I think those that suffer with this condition should be made aware and should not feel that they have to mask it, tough it out, and suffer through its pangs. Though you seem that what you describe is actual hypoglycemia, "IPS" can be just as debilitating, and it can be hard to deal with without proper medical recognition.

I also object to this article being classified as "low-importance" by wikipedia. This, to me, speaks to the very general regard for IPS in the medical establishment and the public consciousness.