Schoenberger Jennifer Leung, Koh Chung-Kay, Hor Tiffany, Baldwin David, Reddy Arati, Rondinelli-Hamilton Lara
Section of Endocrinology, Rush University Medical Center, Chicago, IL 60612, USA.
Case Rep Endocrinol. 2012;2012:427565. doi: 10.1155/2012/427565. Epub 2012 Jun 28.
Objective. We evaluated a 47-year-old woman with a history of type 2 diabetes and severe obesity who developed postprandial hypoglycemia after undergoing Roux-en-Y gastric bypass surgery and losing 60% of her total body weight. We studied her insulin secretion and blood glucose dynamics and were able to tailor a therapeutic regimen involving insulin that eliminated episodes of hypoglycemia. Methods. We studied blood glucose levels during a prolonged fast, performed continuous glucose monitoring studies using a subcutaneous glucose sensor, and evaluated regional pancreatic insulin secretion using selective arterial calcium stimulation. Results. Continuous glucose monitoring revealed that the patient had early (1-2 hr) postprandial hyperglycemia followed by late (3-4 hr) postprandial hypoglycemia. Biochemical studies confirmed endogenous pancreatogenous insulin secretion as the cause of episodic hypoglycemia, but imaging studies and selective arterial calcium stimulation failed to localize an insulinoma. The patient was treated with preprandial doses of insulin aspart in order to attenuate the early postprandial hyperglycemia, and the late hypoglycemic episodes were avoided. Conclusion. We describe an interesting and novel nonsurgical approach to the prevention of postprandial hypoglycemia in a patient with noninsulinoma pancreatogenous hypoglycemia after gastric bypass.
目的。我们评估了一名47岁患有2型糖尿病和严重肥胖症的女性，她在接受胃旁路手术后体重减轻了60%，并出现了餐后低血糖。我们研究了她的胰岛素分泌和血糖动态，并制定了一种包含胰岛素的治疗方案，该方案消除了低血糖发作。方法。我们在长时间禁食期间研究血糖水平，使用皮下葡萄糖传感器进行连续血糖监测研究，并使用选择性动脉钙刺激评估胰腺局部胰岛素分泌。结果。连续血糖监测显示，该患者餐后早期（1 - 2小时）出现高血糖，随后在餐后晚期（3 - 4小时）出现低血糖。生化研究证实内源性胰腺源性胰岛素分泌是发作性低血糖的原因，但影像学研究和选择性动脉钙刺激未能定位胰岛素瘤。该患者接受餐时门冬胰岛素治疗以减轻餐后早期高血糖，并避免了晚期低血糖发作。结论。我们描述了一种有趣且新颖的非手术方法，用于预防胃旁路术后非胰岛素瘤胰腺源性低血糖患者的餐后低血糖。
