title: Reactive hypoglycaemia due to late dumping syndrome: successful treatment with acarbose.
abstract: Reactive hypoglycaemia is a rare disease which occurs postprandially in everyday life involving blood glucose levels below 2.5 to 2.8 mmol/l. We report on a 66-year-old patient who developed symptomatic reactive hypoglycaemia due to late dumping syndrome 10 years after oesophagectomy with cervical anastomosis. A 75 g sucrose load revealed a plasma glucose level of 9.4 mmol/l after one hour, followed by symptomatic hypoglycaemia with a plasma glucose level of 1.8 mmol/l after three hours. Concomitantly, high concentrations of insulin (3216 pmol/l at a glucose level of 9.4 mmol/l and 335 pmol/l at a glucose level of 1.8 mmol/l) and glucagon-like peptide 1 (GLP-1) (375 pmol/l at a glucose level of 9.4 mmol/l and 85 pmol/l at a glucose level of 1.8 mmol/l) were measured. While the patient was under treatment with acarbose, another sucrose load did not provoke symptomatic hypoglycaemia (plasma glucose nadir of 4.6 mmol/l after two hours). Insulin and GLP-1 levels increased much less, to peak levels of 375 pmol/l and 75 pmol/l respectively, after one hour when plasma glucose was 6.8 mmol/l. We conclude that in patients with reactive hypoglycaemia due to gastrointestinal surgery, acarbose decreases rapid glucose absorption associated with hyperglycaemia and GLP-1 secretion, and thus diminishes excessive insulin release. Acarbose is therefore a successful treatment modality for reactive hypoglycaemia due to late dumping syndrome.
authors.affiliation: Medizinische Klinik B, Department of Internal Medicine, University Hospital Zürich, Switzerland. alexander.imhof@dim.usz.ch
authors.forename: A
authors.initials: A
authors.lastname: Imhof
authors.forename: M
authors.initials: M
authors.lastname: Schneemann
authors.forename: A
authors.initials: A
authors.lastname: Schaffner
authors.forename: M
authors.initials: M
authors.lastname: Brändle
mesh_terms: D020909:Acarbose / Q000008:administration & dosage*; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D004377:Dumping Syndrome / Q000150:complications / Q000188:drug therapy*; D016629:Esophagectomy; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology
chemical_list: D001786:Blood Glucose; D020909:Acarbose