反應性低血糖

Reactive Hypoglycemia

戴東原(Tong-Yuan Tai)

《台灣醫學》 24卷3期 (2020/05) Pp. 275-279

https://doi.org/10.6320/FJM.202005_24(3).0005

摘要

功能性反應性低血糖的發作為自發性，跟使用藥物或罹患腫瘤引起的低血糖完全不同，既使不吃東西或尋求醫療，單靠體內調適作用，血糖也會回升。除非是低血糖發作者有嚴重腦部或心臟血管的阻塞，通常不會威脅生命的安全。臨床上遇到功能性反應性低血糖的機會不是很多。但是沒有想到有這種狀況，可能給我們在診斷上帶來困難。發生這種狀況的可能是血糖正常、糖尿病前期或早期糖尿病者。除外因極端肥胖以及肥胖的第二型糖尿病，接受縮小胃或胃繞道手術，因嚴重胃疾病接受胃部分、亞全或完全切除的病人，比較容易聯想到與反應性低血糖關連。由於冒汗、心跳加強、全身虛脫，病人常以為是心臟病發作，造成病人重大恐慌。其實仔細聽病人的描述，再來確診反應性低血糖並不困難，可以消除病人的疑慮及恐慌。預防發作的要領以及一旦發作的處理通常不會太困難。少食多餐，減少碳水化合物的攝取，避免含糖或果汁等飲料，大致上可以控制低血糖的發作。

關鍵字

反應性低血糖 ； GLP-1 ； 胰島素 ； 胃繞道手術

並列摘要

Functional reactive hypoglycemia that occurs spontaneously is completely different from drug-induced or tumor-related hypoglycemia as blood glucose is usually able to return to normal through physiological self-regulation without having to eat something or seek medical treatment. Unless for patients suffering brain or cardiovascular occlusion, reactive hypoglycemia is rarely life-threatening. Functional reactive hypoglycemia can pose difficulty in diagnosis as it is seldom encountered in clinical settings and therefore unlikely to be taken into consideration. It may occur in people of normal glucose tolerance as well as in patients of prediabetes or early-stage diabetes. For patients with severe gastric illness received partial, subtotal or total gastrectomy or in patients with morbid obesity with or without type 2 diabetes underwent gastric volume reduction or gastric bypass surgery, that postprandial reactive hypoglycemic is more likely to enter the picture of diagnosis. Symptoms like sweating, rapid heartbeat, and fatigue may prompt patients into mistaking reactive hypoglycemia as heart attack and experiencing major panics which can be avoided if physicians can pay closer attention to patients’ descriptions and their health status to verify if reactive hypoglycemia is a potential diagnosis. Reactive hypoglycemic prevention and treatment can be as easy as having small frequent meals, reducing consumption of carbohydrates, avoiding sugary beverages and fruit juice.

並列關鍵字

reactive hypoglycemia ； GLP-1 ； insulin ； gastric bypass surgery

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