Arii Kaoru, Ota Kikuko, Suehiro Tadashi, Ikeda Yukio, Nishimura Kanae, Kumon Yoshitaka, Hashimoto Kozo
Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan.
Diabetes Res Clin Pract. 2005 Sep;69(3):305-8. doi: 10.1016/j.diabres.2005.01.004. Epub 2005 Feb 23.
A 42-year-old woman with hypoglycemic symptoms that occurred several hours after a meal visited our hospital. The hypoglycemic symptoms appeared when she was 37 years old, and her plasma glucose level had been assessed as less than 60 mg/dL when she experienced the symptoms. One year before, she had been diagnosed with reactive hypoglycemia by 75 g-oral glucose tolerance test (OGTT), which showed a normal glucose tolerance (NGT) pattern, and had begun taking an alpha-glucosidase inhibitor and nutritional treatment. A 75 g-OGTT on admission showed hypoglycemia at 240 min after glucose loading, excessive insulin secretion and an impaired glucose tolerance (IGT) pattern. A euglycemic-hyperinsulinemic clamp study demonstrated decreased insulin sensitivity. Therefore, we suspected that she had reactive hypoglycemia associated with insulin resistance and treated her with 15 mg/day pioglitazone. Her hypoglycemic symptoms completely disappeared after treatment with pioglitazone; insulin sensitivity in a euglycemic-hyperinsulinemic clamp study improved. Another 75 g-OGTT revealed that the excessive insulin secretion and hypoglycemia at 240 min after glucose loading had disappeared, and glucose tolerance was normalized from an IGT pattern to an NGT pattern. Thus, we believe that pioglitazone is effective for reactive hypoglycemia and aggravated glycemic metabolism associated with insulin resistance.
一名42岁女性，餐后数小时出现低血糖症状，前来我院就诊。低血糖症状在她37岁时出现，症状发作时其血浆葡萄糖水平经评估低于60mg/dL。一年前，她通过75g口服葡萄糖耐量试验（OGTT）被诊断为反应性低血糖，该试验显示葡萄糖耐量正常（NGT）模式，此后她开始服用α-葡萄糖苷酶抑制剂并接受营养治疗。入院时的75g-OGTT显示，葡萄糖负荷后240分钟出现低血糖，胰岛素分泌过多且葡萄糖耐量受损（IGT）模式。正常血糖-高胰岛素钳夹研究显示胰岛素敏感性降低。因此，我们怀疑她患有与胰岛素抵抗相关的反应性低血糖，并给予她每天15mg吡格列酮进行治疗。使用吡格列酮治疗后，她的低血糖症状完全消失；正常血糖-高胰岛素钳夹研究中的胰岛素敏感性得到改善。另一项75g-OGTT显示，葡萄糖负荷后240分钟的胰岛素分泌过多和低血糖现象消失，葡萄糖耐量从IGT模式恢复正常至NGT模式。因此，我们认为吡格列酮对反应性低血糖以及与胰岛素抵抗相关的血糖代谢恶化有效。
