Oxyhyperglycemia

Abstract: OXYHYPERGLYCEMIA, which was first reported by Lawrence1(1936) as a symptomless glycosuria, has recently been implicated as a prediabetic state.2 As already pointed out by Lawrence, oxyhyperglycemia often occurs when there is immediate absorption of glucose from the intestine, especially after gastroenterostomy. However, the incidence and exact nature of oxyhyperglycemia after gastrectomy and its relationship to the prediabetic state are still unknown. The incidence of oxyhyperglycemia in relation to disease, type of surgery, and age was investigated in 100 patients who had undergone gastrectomy. Materials, Methods, and Criteria The glucose tolerance test (GTT) was administered to 100 postgastrectomy patients, of whom 96 had been operated on at this hospital and 4 had received gastrectomy elsewhere and visited our hospital because of glycosuria. Fifty grams of glucose in 325 cc of water was given orally after venous blood had been drawn for fasting blood glucose determinations. Blood glucoses were

Abstract: Plasma immunoreactive insulin and free fatty acid (F.F.A.) responses to an oral glucose load were observed in young students with glycosuria and with glucose intolerance of a slight degree. — The groups with a diabetic or a borderline glucose tolerance test (G.T.T.) had a delayed and protracted plasma insulin and F.F.A. response. Both responses were significantly greater than in the control group. The result indicates that a sluggish but high rise and a delayed fall of plasma insulin during the glucose load is characteristic of chemical diabetics and this tendency is seen in the cases with a borderline G.T.T. — The subjects with oxyhyperglycemic G.T.T. also had an initial delay in the insulin response and the peak was distinctly higher than in the control, but the fall was sharp. This suggests that oxyhyperglycemia is one of the preceding states of diabetes. — The subjects with renal glycosuria, in the definition of Lawrence, had a high-normal G.T.T., but their insulin and F.F.A. responses showed no difference from those of the normal.

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 carbohydrates. It also occurs sometimes in patients on hemodialysis, where it is a potentially lethal complication. Because insulin has a longer half-life due to lack of renal degradation, hypoglycemia can be induced by insulin in patients with renal failure. We treated a patient with frequent episodes of severe hypoglycemia, that were sometimes accompanied by convulsions. He had undergone total gastrectomy 8 years before and had been maintained on hemodialysis for 3 years. Hyperinsulinemia caused by oxyhyperglycemia associated with post-gastrectomy led to severe hypoglycemia in this patient because of the lack of renal insulin degradation. Since nutritional treatment did not successfully manage his reactive hypoglycemia, an alpha-glucosidase inhibitor, acarbose, was administered to treat his oxyhyperglycemia. This therapy was very effective and he has not had any recurrence of reactive hypoglycemia since the initiation of the therapy.

Abstract: An 83-year-old man developed hypoglycemia after undergoing total gastrectomy for gastric cancer in 200X-4. The patient was admitted to our hospital in May 200X and placed on continuous glucose monitoring (CGM). Glycemic excursions were examined while on 3-meal/day (1700kcal) and 6-meal/day (1800kcal) diets. Oxyhyperglycemia followed about 2h later by a sudden drop in glucose levels was seen with both regimens. These findings were consistent with late dumping syndrome. CGM was continued, oral miglitol at 150mg/day or sitagliptin at 50mg/day was started, and glycemic excursions were compared. Results were similar for both drugs, with reductions in postprandial glucose elevations. Meal tolerance testing 3 months after oral sitagliptin, compared to before starting treatment, showed reductions in both early postprandial hyperglycemia and insulin hypersecretion. These findings suggest that DPP-4 inhibitors such as sitagliptin may be effective for treating post-gastrectomy late dumping syndrome.