Reactive hypoglycaemia is a
rare disease which occurs postprandially in everyday life involving
blood glucose levels below 2.5 to 2.8 mmol/l. We report on a 66-year-old patient who developed symptomatic reactive hypoglycaemia due to late
dumping syndrome 10 years after oesophagectomy with cervical anastomosis. A 75 g
sucrose load revealed a plasma
glucose level of 9.4 mmol/l after one hour, followed by symptomatic hypoglycaemia with a plasma
glucose level of 1.8 mmol/l after three hours. Concomitantly, high concentrations of
insulin (3216 pmol/l at a
glucose level of 9.4 mmol/l and 335 pmol/l at a
glucose level of 1.8 mmol/l) and
glucagon-like peptide 1 (GLP-1) (375 pmol/l at a
glucose level of 9.4 mmol/l and 85 pmol/l at a
glucose level of 1.8 mmol/l) were measured. While the patient was under treatment with
acarbose, another
sucrose load did not provoke symptomatic hypoglycaemia (plasma
glucose nadir of 4.6 mmol/l after two hours).
Insulin and
GLP-1 levels increased much less, to peak levels of 375 pmol/l and 75 pmol/l respectively, after one hour when plasma
glucose was 6.8 mmol/l. We conclude that in patients with reactive hypoglycaemia due to gastrointestinal surgery,
acarbose decreases rapid
glucose absorption associated with hyperglycaemia and
GLP-1 secretion, and thus diminishes excessive
insulin release.
Acarbose is therefore a successful treatment modality for reactive hypoglycaemia due to late
dumping syndrome.