Treatment with alpha-glucosidase inhibitor for severe reactive hypoglycemia: A case report / 대한내과학회지

ABSTRACT

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 carbohydrate. We treated the patient with frequent episode of severe hypoglycemia. Reactive hypoglycemia is caused by an excessive insulin secretion after a sharp rise in plasma glucose. He had undergone total gastrectomy due to stomach cancer 4 years before. Since nutritional treatment did not successfully manage his reactive hypoglycemia, an alpha-glucosidase inhibitor, voglibose was administered. His hypoglycemic symptoms disappeared and a rapid change of plasma glucose and insulin levels were attenuated after the alpha-glucosidase inhibitor treatment. The effects of alpha-glucosidase inhibitor were documented in a 5-hour oral glucose tolerance test, where not only insulin and C-peptide rise was clearly attenuated, but also the blood glucose concentration did not fall low enough to induce hypoglycemic symptoms. This therapy was very effective and the patient has not had any recurrence of reactive hypoglycemia since the initiation of the therapy.