Poster Presentation ESA-SRB-APEG-NZSE 2022

Hypoglycaemia in Eating Disorders (#315)

Xi May Zhen 1 , Ian Caterson 1 2
  1. Department of Endocrinology, Royal Prince Alfred Hospital, Sydney
  2. Charles Perkins Centre, University of Sydney

Eating disorders are characterised by a persistent disturbance of eating-related behaviour that results in the altered consumption or absorption of food, and significantly impairs physical health or psychosocial functioning.1 Hypoglycaemia is common in eating disorders. An US cohort study of adult inpatients with severe anorexia nervosa (AN) found that a blood glucose level (BGL) < 3.3mmol/L occurred in 44% of patients and a BGL < 2.2 mmol/L occurred in 12% of patients.2 Severe derangement of liver enzymes predicted the development of mild hypoglycaemia.2

Hypoglycaemia may have deleterious effects on patients' ability to perform high risk tasks safely, especially when there is impaired hypoglycaemia awareness. The pathophysiology of hypoglycaemia in eating disorders is multifactorial. Dietary restriction and excessive exercise results in the depletion of hepatic glycogen stores and impaired hepatic gluconeogenesis.3 Impaired glucagon secretion has also been described.4 Refeeding can also result in hypoglycaemia, particularly in those with prolonged and severe malnutrition. An Australian cohort study of inpatients at a specialist eating disorders unit found that, following a mixed meal, 22% of patients recorded a postprandial BGL <3.5 mmol/l  and 3.9% of patients recorded a postprandial BGL < 2 mmol/L.5 Only low BMI significantly predicted postprandial hypoglycaemia.5

There is limited case report data to suggest that postprandial hypoglycaemia may occur with refeeding after starvation as a result of exaggerated insulin secretion during the very early phase.6 Early studies in people with AN produced inconsistent results regarding insulin sensitivity7, 8, and the glucose and insulin response post-glucose load has been shown to vary based on OGTT results prior to refeeding.9 There is limited data to suggest that insulin clearance is significantly increased in people with AN10.

This presentation will include a critical review of the existing literature on hypoglycaemia and eating disorders, and we will also discuss usual practice and management strategies in the context of existing guidelines.

  1. Feeding and Eating Disorders. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, Virginia: American Psychiatric Association; 2013.
  2. Gaudiani JL, Sabel AL, Mascolo M, Mehler PS. Severe anorexia nervosa: outcomes from a medical stabilization unit. Int J Eat Disord. 2012;45(1):85-92.
  3. Kohn MR, Madden S, Clarke SD. Refeeding in anorexia nervosa: increased safety and efficiency through understanding the pathophysiology of protein calorie malnutrition. Curr Opin Pediatr. 2011;23(4):390-4.
  4. Fujii S, Tamai H, Kumai M, Takaichi Y, Nakagawa T, Aoki TT. Impaired glucagon secretion to insulin-induced hypoglycemia in anorexia nervosa. Acta Endocrinol (Copenh). 1989;120(5):610-5.
  5. Hart S, Abraham S, Franklin RC, Twigg SM, Russell J. Hypoglycaemia following a mixed meal in eating disorder patients. Postgrad Med J. 2011;87(1028):405-9.
  6. Yasuhara D, Deguchi D, Tsutsui J, Nagai N, Nozoe S, Naruo T. A characteristic reactive hypoglycemia induced by rapid change of eating behavior in anorexia nervosa: a case report. Int J Eat Disord. 2003;34(2):273-7.
  7. Scheen AJ, Castillo M, Lefèbvre PJ. Insulin sensitivity in anorexia nervosa: a mirror image of obesity? Diabetes Metab Rev. 1988;4(7):681-90.
  8. Hermans MP, Lambert MJ. HOMA-modelling of insulin sensitivity and β-cell function in anorexia nervosa. European Eating Disorders Review. 2002;10(1):41-50.
  9. Nozaki T, Tamai H, Matsubayashi S, Komaki G, Kobayashi N, Nakagawa T. Insulin response to intravenous glucose in patients with anorexia nervosa showing low insulin response to oral glucose. J Clin Endocrinol Metab. 1994;79(1):217-22.
  10. Letiexhe MR, Scheen AJ, Lefèbvre PJ. Plasma leptin levels, insulin secretion, clearance and action on glucose metabolism in anorexia nervosa. Eat Weight Disord. 1997;2(2):79-86.