A 45-year-old woman who had undergone total
gastrectomy for
gastric cancer presented with a history of postprandial
hypoglycemic episodes with
loss of consciousness after meals. Laboratory findings revealed marked
hyperinsulinemia and
hypoglycemia after a meal. We first treated the patient with
octreotide; however, she was unable to continue the treatment because of adverse effects of the
drug, such as
nausea and
headache.
Diazoxide was used next for preventing
hyperinsulinemia; however, this was not effective for suppressing the postprandial insulin secretion. Since
hypoglycemia following
gastrectomy is thought to be caused by rapid delivery of nutrients into the duodenum, we performed a meal tolerance test while varying the timing of administration of
miglitol in relation to the meal.
Miglitol was administered 30 min before, just before, or both 30 min and just before a meal. In the case of administration just before a meal, insulin secretion was suppressed, although
hypoglycemia was not prevented. Administration of the
drug 30 min before a meal prevented
postprandial hypoglycemia by slowing the increase of the
blood glucose and serum
insulin levels following the meal to a greater degree than administration just before a meal.
Miglitol administration both 30 min and just before a meal caused an even smoother increase in
blood glucose and serum
insulin levels following the meal. In this report, we propose a new therapeutic approach for
reactive hypoglycemia after
gastrectomy, namely, administration of
miglitol 30 min before meals.