Abstract
A 64-year-old woman, who had previously been diagnosed with chronic hepatitis B, developed postprandial hypoglycemia. She had refused to take antiviral drugs. The HbA1c level was 5.7 % according to the NGSP value. On a 5-hour 75-g OGTT, hyperglycemia (314 mg/dl) with hyperinsulinemia (195.4 μU/ml) appeared at 1.5-2 hours and symptomatic hypoglycemia (44 mg/dl) appeared at five hours. On a 25-g IVGTT, hyperglycemia (396 mg/dl) appeared at five minutes, followed by hyperinsulinemia (40-50 μU/ml) at 10-90 minutes with symptomatic hypoglycemia (50 mg/dl). The possibility of an insulinoma was considered to be very low, as no hypoglycemic events were induced during an 18-hour fast and no pancreatic tumors were detected. The prescription of a divided diet and treatment with voglibose was effective in reducing the patient's hypoglycemia. A splenorenal shunt and arterioportal shunt were subsequently detected on a CT scan. Conclusions: In the present case, delayed hyperglycemia and hyperinsulinemia were observed on a 75-g OGTT. Changes in the patient's hemodynamic state due to the presence of shunt vessels and alterations in glucose-insulin metabolism were thought to be the cause of severe hyperglycemia and hypoglycemia in this case.
