위전절제술 후 발생한 반응성 저혈당증을 α-Glucosidase Inhibitor로 치료한 1예
Treatment with α-glucosidase inhibitor for severe reactive hypoglycemia: A case report
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위절제술이나 미주신경절제술 후에는 음식물, 특히 탄수화물의 빠른 소화와 흡수로 인한 반응성 저혈당증이 발생할 수 있는데 어떤 경우에는 혈장 포도당이 30∼40 mg/dL까지 감소할 수도 있다. 반응성 저혈당증은 급격한 혈장 포도당의 상승 후 과다한 인슐린 분비가 원인이다. 저자들은 내원 4년 전 위암으로 위전절제술을 시행받은 후 발생한 빈번하고도 심한 저혈당증 환자를 치료하였다. 영양 치료법으로는 환자의 반응성 저혈당증을 치료하기 어려워 α-glucosidase inhibitor인 voglibose를 투여하였다. α-glucosidase inhibitor 투여 후 환자의 저혈당 증상은 나타나지 않았고 급격한 혈장 포도당과 인슐린의 변화 양상도 감소하였다.
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 α-glucosidase inhibitor, voglibose was administered. His hypoglycemic symptoms disappeared and a rapid change of plasma glucose and insulin levels were attenuated after the α-glucosidase inhibitor treatment. The effects of α-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.(Korean J Med 63:335-339, 2002)