pectins and Hypoglycemia

In a double-blind study we have compared the effect of 50 mg acarbose, 100 mg acarbose, 4.2 g pectin, a combination of 50 mg acarbose with 4.2 g pectin, and placebo on plasma glucose, plasma insulin, breath hydrogen and hypoglycaemic symptoms after a normal carbohydrate rich meal in nine patients with previous gastric surgery. Fifty milligrams acarbose, 100 mg acarbose and the combination of 50 mg acarbose with 4.2 g pectin significantly inhibited the postprandial peak glucose concentration (p less than 0.01). The lowest plasma glucose concentration, observed 60-150 minutes after ingestion of the meal, was significantly increased by the addition of 50 mg acarbose (p less than 0.01) and the combination of acarbose with pectin (p less than 0.05). The combination of acarbose with pectin was the only treatment that significantly inhibited the plasma insulin peak (p less than 0.05). Eight of nine patients had symptoms of hypoglycaemia on placebo, two on 50 mg acarbose (p less than 0.05), two on 100 mg acarbose (p less than 0.05), five on pectin (ns), and two on the combination of acarbose and pectin (p less than 0.05). All treatments with acarbose induced significant increases in breath hydrogen excretion (p less than 0.05).

Topics: Acarbose; Adult; Blood Glucose; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Hydrogen; Hypoglycemia; Insulin; Male; Middle Aged; Oligosaccharides; Pectins; Postgastrectomy Syndromes; Trisaccharides

Twelve patients with the dumping syndrome took on one occasion oral hypertonic glucose and on another a similar glucose drink to which pectin was added. After glucose alone eleven patients had symptoms; after glucose with pectin, six had no symptoms and in five symptoms were reduced. Plasma volume changes were significantly less after glucose with pectin, and the hypoglycaemia at 120 min after glucose alone did not occur after glucose with pectin in patients in whom symptoms were abolished. Gastric emptying was prolonged, and serum insulin levels were lower, after glucose with pectin. In those patients to whom gastric emptying rate reverted to near normal with pectin, symptoms were abolished, but symptoms were only reduced in number when gastric emptying, although slowed, remained rapid. The findings suggest that pectin and similar substances may be useful in the day-to-day management of patients with dumping symptoms.

Topics: Adult; Dumping Syndrome; Female; Gastric Emptying; Humans; Hypoglycemia; Insulin; Male; Middle Aged; Pectins; Plasma Volume

Pectin has been shown to minimise the fall in blood glucose seen in patients who are troubled by hypoglycaemia attacks after gastric surgery. We therefore performed 50 g glucose tolerance tests with and without 14.5 g pectin on 11 post-gastric surgery patients. After pectin, the high postprandial levels of glucose, insulin, and enteroglucagon were significantly reduced as was the fall in blood glucose between 90 and 120 minutes. These effects of pectin may reflect slower uptake of glucose from the gastrointestinal tract and provide evidence to support the use of unabsorbable carbohydrate gelling agents in treating hypoglycaemia after gastric surgery.

Topics: Adult; Aged; Blood Glucose; Female; Food; Gastrectomy; Gastric Emptying; Gastrointestinal Hormones; Glucose Tolerance Test; Humans; Hypoglycemia; Insulin; Male; Middle Aged; Pectins; Postoperative Complications; Vagotomy

In 23 patients previously operated on the stomach, the effect of pectin and wheat bran on the glucose tolerance test (G.T.T.) has been studied. If wheat bran had no significant effect on the glucose tolerance curve, pectin had a significant effect, lowering blood glucose value before the 90th minute (1,32 +/- 0,33 g/l as against 1,87 +/- 0,23 on the 30th minute) and elevating blood glucose value after the 90th minute of the G.T.T. (0.90 +/- 0,30 as against 0, 63 +/- 0,26 on the 120th minute). Therapeutic efficiency of pectin was confirmed in three patients who had symptoms of hypoglycaemia, which disappeared with the intake of 5 g of pectin before each meal.

Topics: Adult; Aged; Blood Glucose; Female; Gastrectomy; Glucose Tolerance Test; Humans; Hypoglycemia; Male; Middle Aged; Pectins; Time Factors; Triticum

Nineteen patients suffering from chemical diabetes either with (group A, ten cases) or without (group B, nine cases) reactive hypoglycaemia were included in the study and compared with seven control (group C). The following variables were measured over a 5 hour period during a standard oral glucose tolerance test (OGTT): (i) blood glucose by continuous monitoring; (ii) plasma insulin and glucagon levels by radioimmunoassay. Furthermore, in five diabetics of group A, the data from the standard OGTT were compared with those from a pectin-supplemented OGTT (9 g per square meter of body surface). Although the insulin response was similar glucagon levels were significantly higher (45.1 +/- 11.8 pmol/l) (p less than 0.01) in group B than in group A (9.6 +/- 1.3) and C (8.1 +/- 1.4 at 30 minutes). The high glucagon levels noted in group B may explain the absence of reactive hypoglycaemia. The pectin supplementation improved the OGTT pattern by blunting the blood glucose peak (p less than 0.05), and avoiding the reactive hypoglycaemia (p less than 0.01). The addition of pectin did not produce any significant effect on the insulin response while a significant increase in glucagon concentrations (p less than 0.05) was observed beyond the 150th minute. Therefore, the data suggest that pectin may improve the OGTT pattern by increasing the glucagon response in the late period of the test. The development of postprandial reactive hypoglycaemia seldom coincides with a plasma glucagon peak, while the absence of reactive hypoglycaemia tends to be associated with high levels of glucagon, as is the case in overt diabetes mellitus.

Topics: Adult; Aged; Blood Glucose; Diabetes Mellitus; Female; Glucagon; Glucose Tolerance Test; Humans; Hyperglycemia; Hypoglycemia; Male; Middle Aged; Pectins

Topics: Dietary Carbohydrates; Humans; Hypoglycemia; Pectins; Postgastrectomy Syndromes; Stomach

Topics: Adult; Dumping Syndrome; Gastric Emptying; Humans; Hypoglycemia; Male; Pectins

The dumping syndrome is a very troublesome problem to some patients after gastric surgery. Gel-forming carbohydrates have recently been used to modify glucose absorption. The addition of 14.5 g of pectin to a 50-g oral glucose load prevented the occurrence of hypoglycemic symptoms and maintained the blood glucose levels above control values by 64% at 90 min (P less than 0.002) and 46% at 120 min (P less than 0.01) in postgastric surgery patients whose 120-min values after 50 g of glucose alone had fallen below 50 mg per 100 ml (2.8 mmoles per liter). Breath H2 production, used as an index of bacterial fermentation of glucose, was abolished or reduced by pectin in all 5 cases in which this had previously occurred. A trial of 10 g of pectin per day prevented recurrent postprandial hypoglycemic attacks in the most severely affected individual. Pectin and perhaps other unabsorbable polysaccharides are likely to prove useful in the treatment of abnormal carbohydrate absorption after gastric surgery.

Topics: Adult; Aged; Blood Glucose; Cellulose; Dietary Fiber; Female; Humans; Hypoglycemia; Malabsorption Syndromes; Male; Middle Aged; Pectins; Postgastrectomy Syndromes; Pyloric Antrum; Vagotomy