Treatment with alpha-glucosidase inhibitor for severe reactive hypoglycemia: a case report.
Gastrectomy or vagotomy may result in reactive hypoglycemia, which, in some cases, can reduce the plasma glucose levels to 30-40 mg/dl due to rapid digestion and absorption of food, especially carbohydrates. It also occurs sometimes in patients on hemodialysis, where it is a potentially lethal complication. Because insulin has a longer half-life due to lack of renal degradation, hypoglycemia can be induced by insulin in patients with renal failure. We treated a patient with frequent episodes of severe hypoglycemia, that were sometimes accompanied by convulsions. He had undergone total gastrectomy 8 years before and had been maintained on hemodialysis for 3 years. Hyperinsulinemia caused by oxyhyperglycemia associated with post-gastrectomy led to severe hypoglycemia in this patient because of the lack of renal insulin degradation. Since nutritional treatment did not successfully manage his reactive hypoglycemia, an alpha-glucosidase inhibitor, acarbose, was administered to treat his oxyhyperglycemia. This therapy was very effective and he has not had any recurrence of reactive hypoglycemia since the initiation of the therapy.
Teno
S
S
Saitamaken Saiseikai Kurihashi Hospital, Saitama, Japan.
Nakajima-Uto
Y
Y
Nagai
K
K
Shimizu-Saitoh
M
M
Ozu
H
H
Omori
Y
Y
Takizawa
T
T
D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005743:Gastrectomy / Q000009:adverse effects; D065089:Glycoside Hydrolase Inhibitors; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index
D004791:Enzyme Inhibitors; D065089:Glycoside Hydrolase Inhibitors