Proposed treatment strategy for reactive hypoglycaemia

Background/aim: Managing reactive hypoglycaemia (RH) poses challenges due to limited and often ineffective treatment options. We report a case series and draw on this to propose a stepwise treatment approach consisting of lifestyle modifications, metformin, GLP-1 analogues, and the use of flash glucose monitoring technology. Method: A retrospective review was conducted to analyse the management of 11 cases presenting with recurrent RH symptoms. Result: Two patients experienced successful resolution of symptoms through lifestyle modifications. Metformin alone was effective in treating seven out of nine patients who received pharmacological treatment. Two patients with previous upper gastrointestinal surgery showed a partial response to metformin and benefited further from additional long-acting GLP-1 analogue. Pharmacological intervention led to significant reductions in insulin and C-peptide levels in repeat mixed meal tolerance tests (P-values 0.043 for insulin and 0.006 for C-peptide). Finally, flash glucose monitoring technology was useful in early detection and preventing episodes of hypoglycaemia in one of these patients with persistent symptoms. Conclusion: These findings highlight the potential efficacy of escalated treatment strategies for RH, including the use of metformin, GLP-1 analogues, and flash glucose monitoring technology

The Role of Carotid Artery Screening Before Coronary Artery Bypass Graft Surgery

Background: The incidence of stroke is 2.1-5.2% in bypass surgery patients with a mortality of 0-38%. This study was designed to evaluate the incidence of significant carotid artery stenosis and its related risk factors in candidates for coronary artery bypass graft (CABG) surgery. Methods: 1045 consecutive candidates for CABG underwent carotid artery Doppler examination in a prospective study. The relation of age, sex, smoking and diabetes as well as lipid profile and carotid stenosis was evaluated. . Results: In 1045 CABG candidates with the mean age of 60 years, the prevalence of significant carotid stenosis (>60%) was 6.9%. In the patients who aged 65 years and older, significant stenosis was12.5%. Age of 50 years and above, female gender, hypercholesterolemia and diabetes mellitus are independent risk factors for significant carotid stenosis. Conclusion: Significant carotid stenosis has an earlier beginning in our study. Cost effectiveness studies are recommended for revising the previous screening protocols

Bile acid metabolism is altered in those with insulin resistance after gestational diabetes mellitus.

Bile acids (BAs) are known mediators of glucose metabolism that are altered in type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM). We hypothesised that post-prandial BA fractions are changed in women with Insulin resistance (IR) after recovery from GDM using homeostatic model assessment (HOMA-IR)