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International Journal of Endocrinology
Volume 2018, Article ID 1528437, 6 pages
Research Article

Fasting-Evoked En Route Hypoglycemia in Diabetes (FEEHD): An Overlooked Form of Hypoglycemia in Clinical Practice

1Division of Endocrinology, Department of Medicine, College of Human Medicine, Michigan State University, USA
2Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, USA
3College of Osteopathic Medicine, Michigan State University, USA
4Division of Cardiology, Department of Medicine, College of Human Medicine, Michigan State University, USA
5University of Michigan-Flint, USA
6College of Human Medicine, Michigan State University, USA
7Wayne State University, USA
8College of Human Medicine-Flint, Michigan State University, USA
9Michigan State University Extension-Flint, USA

Correspondence should be addressed to Saleh Aldasouqi;

Received 21 May 2018; Revised 7 August 2018; Accepted 26 August 2018; Published 24 October 2018

Academic Editor: Tatsuya Kin

Copyright © 2018 Saleh Aldasouqi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. Many patients with diabetes opt to fast for lab tests, especially for lipid profiles, thus missing breakfast. In parallel, recent studies and international guidelines have indicated that routine fasting for lipid panels may not be necessary. Missing breakfast while fasting for lab tests may invoke hypoglycemia, if patients are not properly instructed about adjusting diabetes medications on the night before or on the day of the lab test. Our group described this form of hypoglycemia and introduced the term FEEHD to refer to it (fasting-evoked en route hypoglycemia in diabetes). In a recently published small study, we reported a rate of occurrence of FEEHD of 27.1%. The objective of this study was to evaluate the rate of occurrence of FEEHD in another clinic. Methods. Patients with diabetes were asked to complete a simple, 2-page survey inquiring about hypoglycemic events while fasting for labs in the preceding 12 months. Results. A total of 525 patients completed the surveys out of 572 patients invited (91.8% response rate). A total of 363 patients with complete data were analyzed, with a mean age of 60.6 (SD 12.5) years. A total of 62 (17.1%) patients reported having experienced one or more FEEHD events in the prior 12 months. Of the 269 patients who were at higher risk of FEEHD (on insulin secretagogues or on insulin), 59 (21.9%) reported having experienced FEEHD. Only 33 of FEEHD patients (53%) recalled having contacted their provider regarding the events and only 22 (35%) indicated having received some sort of FEEHD prevention instructions. Conclusion. Our study shows a significant rate of occurrence of FEEHD in the real world (a clinical practice). FEEHD is especially dangerous, as patients often commute (drive) to and from the laboratory facility (potential risk of traffic accidents). Given study limitations, further studies are needed to assess prevalence of FEEHD in other settings and in the general populations.