Insulin in the medical management of postprandial hypoglycemia in a patient with type 2 diabetes after gastric bypass surgery
| Autor: | Tiffany Hor, David S. Baldwin, Jennifer Leung Schoenberger, Arati Reddy, Lara Rondinelli-Hamilton, Chung-Kay Koh |
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| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
lcsh:RC648-665 endocrine system diseases Gastric bypass surgery business.industry Endocrinology Diabetes and Metabolism Insulin medicine.medical_treatment nutritional and metabolic diseases Case Report Type 2 diabetes Hypoglycemia medicine.disease medicine.disease_cause Gastroenterology lcsh:Diseases of the endocrine glands. Clinical endocrinology Insulin aspart Postprandial Endocrinology Internal medicine medicine business Insulinoma medicine.drug Postprandial Hypoglycemia |
| Zdroj: | Case Reports in Endocrinology Case Reports in Endocrinology, Vol 2012 (2012) |
| ISSN: | 2090-651X |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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