Abstract
A 74-year-old man with slowly progressive insulin-dependent diabetes mellitus (IDDM) was admitted to our hospital. He suffered from gastric cancer and was treated by total gastrectomy one year earlier. Since then, postprandial hyperglycemia followed by preprandial hypoglycemic attacks impaired the control of blood glucose levels, which was not corrected by intensive insulin therapy with food intake divided into 6 times per day. Introduction of an α-glucosidase inhibitor (α-GI, voglibose, 0.6 mg per day) in combination with the intensive insulin therapy resulted in well controlled plasma glucose levels, and the hypoglycemic attacks subsided. Oral administration of 75 g of sucrose after treatment with regular insulin (7 IU, sc) with or without voglibose (0.2 mg, po) administration revealed that voglibose corrected the hyperglycemia at 90 min, with no hypoglycemia at 180 min. Hemoglobin Alc levels improved from 9.6% to 7.8%. These findings suggest that α-GI is a useful supplement for the control of plasma glucose by intensive insulin therapy in a totally gastrectomized patient with IDDM.
