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 di gestion and absorption of food, especially carbohydrates. It also occurs so metimes in patients on hemodialysis, where it is a potentially lethal compl ication. Because insulin has a longer half-life due to lack of renal degrad ation, hypoglycemia can be induced by insulin in patients with renal failur e. We treated a patient with frequent episodes of severe hypoglycemia, that we re sometimes accompanied by convulsions. He had undergone total gastrectomy 8 years before and had been maintained on hemodialysis for 3 years. Hyperi nsulinemia 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 r eactive hypoglycemia, an ru-glucosidase inhibitor, acarbose, was administer ed to treat his oxyhyperglycemia. This therapy was very effective and he ha s not had any recurrence of reactive hypoglycemia since the initiation of t he therapy.