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Insulinoma presenting with postprandial hypoglycemia and a low body mass index:A case report

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World Journal of Clinical Cases 2020年第18期8卷 4169-4176页

作者： Dana Prídavková Matej Samoš Roman Kyčina Katarína Adamicová Michal Kalman Margita Belicová Marián Mokáň Clinic of Internal Medicine Ⅰ Comenius University in BratislavaJessenius Faculty of Medicine in MartinMartin 03601Slovakia Clinic of Surgery and Transplant Center Comenius University in BratislavaJessenius Faculty of Medicine in MartinMartin 03601Slovakia Department of Pathological Anatomy Comenius University in BratislavaJessenius Faculty of Medicine in MartinMartin 03601Slovakia

BACKGROUND Insulinomas are the most common type of functioning endocrine neoplasms of the pancreas presenting hypoglycemic symptoms.Patients characteristically develop symptoms while fasting,but some patients have reported symptoms only in the postprandial state.Repeated and prolonged hypoglycemic episodes can reduce the awareness of adrenergic symptoms,and patients may have amnesia,which delays diagnosis.CASE SUMMARY We describe a case of a 24-year-old underweight patient who showed hypoglycemic symptoms for almost 6 years.Although patients with insulinoma characteristically develop symptoms while fasting,this young man had hypoglycemic symptoms up to one hour postprandially,especially after highsugar meals and after physical activity.The fasting tests and imaging methods performed at local hospitals were evaluated as negative for abnormal results.However,brown adipose tissue exhibited increased metabolic activity,and some muscle groups had histological changes as indicated by positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography.Glycogen deficiency was also histologically confirmed.The patient’s symptoms progressed over the years and occurred more frequently,i.e.,several times a month,and the patient had reduced awareness of adrenergic symptoms.The follow-up fasting test was positive,and the imaging results showed a tumor in the head of the pancreas.The patient underwent laparotomy with enucleation of the insulinoma.CONCLUSION Weight gain and fasting hypoglycemia are not necessarily characteristics of insulinoma.In prolonged cases,adrenergic symptoms can be suppressed.

关键词： Brown adipose tissue Glycogen deficit hypoglycemia Insulinoma Underweight Case report

The hypoglycemic potential of phenolics from functional foods and their mechanisms

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Food Science and Human Wellness 2023年第4期12卷 986-1007页

作者： Oksana Golovinskaia Chin-Kun Wang Department of Nutrition Chung Shan Medical UniversityTaiwan 402China

Long-term postprandial hyperglycemia is a primary risk factor for developing chronic metabolic diseases such as obesity,type 2 diabetes,and cardiovascular disease.Chronic hyperglycemia induces the glycation of proteins,oxidative stress,inflammation and increases plasma insulin and lipid concentrations.Insulin resistance is the primary cause of postprandial excursions of blood glucose and lipids.Hyperglycemia can be treated by lowering dietary carbohydrates intake,digestion,and absorption.Various functional foods improve glucose metabolism by increasing insulin sensitivity and inhibitingα-glucosidase in the small intestine.Natural phytochemicals,especially active phenolics are good antioxidants and show anti-inflammatory action and regulate blood glucose.This review aimed to report on hypoglycemic properties of active phenolics from functional foods and their proposed anti-diabetic mechanisms.Nevertheless,further clinical trials are required to confirm the bioavailability,safety,and efficacy of phenolics,especially the dosage and duration of treatment,to avoid adverse effects and give better dietary recommendations.

关键词： Phenolics Functional foods hypoglycemia Insulin resistance Insulin secretion

Role of dipeptidyl peptidase 4 inhibitors in the new era of antidiabetic treatment

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World Journal of Diabetes 2022年第2期13卷 85-96页

作者： Matilda Florentin Michael S Kostapanos Athanasia K Papazafiropoulou Department of Internal Medicine School of MedicineUniversity of IoanninaIoannina 45221Greece Lipid Clinic Department of General MedicineCambridge University Hospitals NHS Foundation TrustAddenbrooke's HospitalCambridge CB20QQUnited Kingdom 1st Department of Internal Medicine and Diabetes Center Tzaneio General Hospital of PiraeusAthens 18536Greece

The last few years important changes have occurred in the field of diabetes treatment.The priority in the therapy of patients with diabetes is not glycemic control per se rather an overall management of risk factors,while individualization of glycemic target is suggested.Furthermore,regulatory authorities now require evidence of cardiovascular(CV)safety in order to approve new antidiabetic agents.The most novel drug classes,i.e.,sodium-glucose transporter 2 inhibitors(SGLT2-i)and some glucagon-like peptide-1 receptor agonists(GLP-1 RA),have been demonstrated to reduce major adverse CV events and,thus,have a prominent position in the therapeutic algorithm of hyperglycemia.In this context,the role of previously used hypoglycemic agents,including dipeptidyl peptidase 4(DPP-4)inhibitors,has been modified.DPP-4 inhibitors have a favorable safety profile,do not cause hypoglycemia or weight gain and do not require dose uptitration.Furthermore,they can be administered in patients with chronic kidney disease after dose modification and elderly patients with diabetes.Still,though,they have been undermined to a third line therapeutic choice as they have not been shown to reduce CV events as is the case with SGLT2-i and GLP-1 RA.Overall,DPP-4 inhibitors appear to have a place in the management of patients with diabetes as a safe class of oral glucose lowering agents with great experience in their use.

关键词： Cardiovascular safety Dipeptidyl peptidase 4 inhibitors Glucose lowering hypoglycemia Therapeutic algorithm Weight gain

Diabetes and cognitive function:An evidence-based current perspective

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World Journal of Diabetes 2023年第2期14卷 92-109页

作者： Meghna Julian Sebastian Shahanas KA Khan Joseph M Pappachan Mohammad Sadiq Jeeyavudeen School of Life Sciences Keele UniversityStoke-on-Trent ST55BGUnited Kingdom Department of Endocrinology and Metabolism Lancashire Teaching Hospitals NHS TrustPreston PR29HTUnited Kingdom Faculty of Science Manchester Metropolitan UniversityManchester M156BHUnited Kingdom Faculty of Biology Medicine and HealthThe University of ManchesterManchester M139PLUnited Kingdom Department of Endocrinology and Metabolism University Hospitals of EdinburghEdinburgh EH164SAUnited Kingdom

Several epidemiological studies have clearly identified diabetes mellitus(DM)as a major risk factor for cognitive dysfunction,and it is going to be a major public health issue in the coming years because of the alarming rise in diabetes prevalence across the world.Brain and neural tissues predominantly depend on glucose as energy substrate and hence,any alterations in carbohydrate metabolism can directly impact on cerebral functional output including cognition,executive capacity,and memory.DM affects neuronal function and mental capacity in several ways,some of which include hypoperfusion of the brain tissues from cerebrovascular disease,diabetes-related alterations of glucose transporters causing abnormalities in neuronal glucose uptake and metabolism,local hyper-and hypometabolism of brain areas from insulin resistance,and recurrent hypoglycemic episodes inherent to pharmacotherapy of diabetes resulting in neuronal damage.Cognitive decline can further worsen diabetes care as DM is a disease largely self-managed by patients.Therefore,it is crucial to understand the pathobiology of cognitive dysfunction in relation to DM and its management for optimal long-term care plan for patients.A thorough appraisal of normal metabolic characteristics of the brain,how alterations in neural metabolism affects cognition,the diagnostic algorithm for patients with diabetes and dementia,and the management and prognosis of patients when they have this dangerous combination of illnesses is imperative in this context.This evidence-based narrative with the backup of latest clinical trial reviews elaborates the current understanding on diabetes and cognitive function to empower physicians to manage their patients in day-to-day clinical practice.

关键词： Diabetes mellitus Dementia Cognitive function Antidiabetic medications Hyperglycemia hypoglycemia

Mitochondrial hepatopathy: Anticipated difficulties in management of fatty acid oxidation defects and urea cycle defects

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World Journal of Hepatology 2022年第1期14卷 180-194页

作者： Aathira Ravindranath Moinak Sen Sarma Division of Pediatric Gastroenterology Institute of Gastrointestinal SciencesApollo BGS HospitalsMysore 570023KarnatakaIndia Pediatric Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical SciencesLucknow 226014Uttar PradeshIndia

Fatty acid oxidation defects(FAOD)and urea cycle defects(UCD)are among the most common metabolic liver diseases.Management of these disorders is dotted with challenges as the strategies differ based on the type and severity of the defect.In those with FAOD the cornerstone of management is avoiding hypoglycemia which in turn prevents the triggering of fatty acid oxidation.In this review,we discuss the role of carnitine supplementation,dietary interventions,newer therapies like triheptanoin,long-term treatment and approach to positive newborn screening.In UCD the general goal is to avoid excessive protein intake and indigenous protein breakdown.However,one size does not fit all and striking the right balance between avoiding hyperammonemia and preventing deficiencies of essential nutrients is a formidable task.Practical issues during the acute presentation including differential diagnosis of hyperammonemia,dietary dilemmas,the role of liver transplantation,management of the asymptomatic individual and monitoring are described in detail.A multi-disciplinary team consisting of hepatologists,metabolic specialists and dieticians is required for optimum management and improvement in quality of life for these patients.

关键词： Mitochondrial hepatopathy Metabolic liver disease Liver transplantation Hyperammonemia hypoglycemia Carnitine

Reliability and validity of the Chinese version of the new fear of hypoglycemia scale: FH-15

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International Journal of Nursing Sciences 2018年第4期5卷 343-351页

作者： Ya-Qian Liu Si-Qi Xiong Ming Sang Yu-Feng Li María Teresa Anarte Ortiz Qiu-Ling Xing Hong-Mei Xu Chang-De Jin Department of Graduate Tianjin University of Traditional Chinese MedicineTianjinChina University of Malaga Spain The Ministry of Health Key Laboratory of Hormone and Development Metabolic Disease Hospital of Tianjin Medical UniversityChina Department of Nursing Tianjin University of Traditional Chinese MedicineTianjinChina

Objective:This study aimed to evaluate the reliability and validity of the Chinese version of the Fear of hypoglycemia scale with 15 items(FH-15).Methods:After obtaining the original author's authorization,the English version of the FH-15 scale was translated,back translated,and culturally debugged to obtain the Chinese version of FH-15.A convenient sampling method was used to extract patients with type 2 diabetes from four tertiary hospitals in Tianjin.A total of 408 patients with type 2 diabetes were investigated in the hospital to test the reliability and validity of Chinese version FH-15 scale.Results:The content validity index of the scale was 0.92,and the content validity index of each item was 0.8-1.0.The exploratory factor analysis extracted three common factors(fear,avoidance,and interference),which contained 15 items,and the cumulative variance contribution rate was 71.245%.The confirmatory factor analysis results showed that the model fit was better at 1.981 x2/df,GFI=0.901,CGI=0.962,TLI=0.952,and RMSEA=0.070.The cut-off value for the total hypoglycemia fear scale was 30.5.The Cronbach'sαcoefficient of the three dimensions of the scale was 0.918,the Cronbach'sαcoefficient of each dimension is 0.876-0.916,the test-retest reliability was 0.903,and the test-retest reliability of each factor was 0.733-0.930.Conclusion:The Chinese version of the FH-15 scale can be considered reliable and valid.The item expression is concise,clear,and easy to understand.It is suitable for clinical practice as an initial screening tool to identify and evaluate the severity of fear of hypoglycemia in patients with type 2 diabetes.

关键词： Diabetes mellitus Type 2 Fear hypoglycemia Reliability Validity

Fasting biochemical hypoglycemia and related-factors in nondiabetic population: Kanagawa Investigation of Total Check-up Data from National Database-8

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World Journal of Diabetes 2021年第7期12卷 1131-1140页

作者： Kotone Tanaka Ryoko Higuchi Kaori Mizusawa Teiji Nakamura Kei Nakajima Graduate School of Health Innovation Kanagawa University of Human ServicesKawasaki 210-0821Japan School of Nutrition and Dietetics Faculty of Health and Social ServicesKanagawa University of Human ServicesYokosuka 238-8522Japan Department of Endocrinology and Diabetes Saitama Medical CenterSaitama Medical UniversityKawagoe 350-8550Japan

BACKGROUND In healthy people,the lowest daily blood glucose concentration is usually observed in the early morning,after overnight fasting.However,the clinical relevance and the prevalence of fasting biochemical hypoglycemia(FBH)are poorly understood in people who do not have diabetes,although the clinical implications of such hypoglycemia have been extensively studied in patients with diabetes.FBH can be influenced by many factors,including age,sex,body mass,smoking,alcohol drinking,exercise levels,medications,and eating behaviors,such as breakfast skipping and late-night eating.AIM To determine the prevalence of FBH and investigated its association with potential risk factors in a population without diabetes.METHODS Clinical parameters and lifestyle-related factors were assessed in a cross-sectional study of 695613 people aged 40-74 years who had undergone a health check-up(390282 men and 305331 women).FBH was defined as fasting plasma glucose<70 mg/dL(3.9 mmol/L)after overnight fasting,regardless of any symptoms.The absence of diabetes was defined as HbA1c<6.5%,fasting plasma glucose<126 mg/dL(7.0 mmol/L),and no pharmacotherapy for diabetes.Multivariate logistic regression analysis,with adjustment for confounding factors,was used to identify associations.RESULTS FBH was present in 1842 participants(0.26%).There were significantly more women in the FBH group(59.1%)than in the non-FBH group(43.9%).Values of most of the clinical parameters,but not age,were significantly lower in the FBH group than in the non-FBH group.Logistic regression analysis showed that a body mass index of≤20.9 kg/m2(reference:21-22.9 kg/m2)and current smoking were significantly associated with FBH,and this was not altered by adjustment for age,sex,and pharmacotherapy for hypertension or dyslipidemia.Female sex was associated with FBH.When the data were analyzed according to sex,men in their 60s or 70s appeared more likely to experience FBH compared with their 40s,whereas men in their 50s and women aged≥50 years appeared less likely to expe

关键词： hypoglycemia Body mass index Age Smoking Women Breakfast skipping

Oral Glucose Combined with Short-Term Intravenous Nutrition for the Prevention of hypoglycemia after Endoscopic Colorectal Polypectomy

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Yangtze Medicine 2023年第3期7卷 155-161页

作者： Li Ma Fan Yang Zhiqin Zhu Tianhao Li Isaac Kumi Adu Peixue Wang Department of Gastroenterology Jianli People’s Hospital Jianli China Department of Gastroenterology The First People’s Hospital of Jingzhou City (The First Affiliated Hospital of Yangtze University) Jingzhou China Endoscopy Center The First People’s Hospital of Jingzhou (The First Affiliated Hospital of Yangtze University) Jingzhou China Health Science Center Yangtze University Jingzhou China Department of Internal Medicine Kings and Queens Medical University College and Teaching Hospital Akosombo Ghana

Objective: To investigate the effect of oral glucose combined with short-term intravenous nutrition on the prevention of hypoglycemia after endoscopic colorectal polypectomy and to provide guidance for better management of such patients. Methods: 860 patients who underwent endoscopic colorectal polypectomy for colorectal polyps in the Department of Gastroenterology of the First Affiliated Hospital of Yangtze University from January 2020 to December 2021 were selected for the study. The patients were divided into experimental and control groups according to the random number table method, with 430 patients in each group. In the control group, 3 L of polyethylene glycol electrolyte dispersion was used for preoperative intestinal preparation and postoperative fasting was performed routinely for 24 h. Short-term intravenous nutrition support was provided by rehydration, and finger blood glucose was monitored at 1, 4, and 8 h after intravenous infusion or when there were symptoms such as panic and cold sweat;in the experimental group, oral glucose intervention was implemented on the basis of the control group. The incidence of postoperative hypoglycemia, quality of bowel preparation, and tolerance of patients during bowel preparation were compared between the 2 groups. Results: The incidence of postoperative blood glucose Conclusion: Based on the present study population, oral glucose combined with short-term intravenous nutrition can effectively prevent the incidence of hypoglycemia in patients after endoscopic colorectal polypectomy;however, this was limited to a single-center study and the number of cases was small.

关键词： Colorectal Polyps Endoscopic Polypectomy Intravenous Nutrition Glucose hypoglycemia

Recurrent ciprofloxacin induced hypoglycemia in a non-diabetic patient:A case report

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World Journal of Pharmacology 2023年第2期12卷 12-17页

作者： Shereen A Dasuqi Linah M Alshaer Rasha A Omran Mohammed A Hamad Department of Pharmacy King Khalid University HospitalKing Saudi University Medical CityRiyadh 11362Saudi Arabia College of Pharmacy Almaarefa UniversityRiyadh 11234Saudi Arabia Department of Pharmaceutics and Pharmaceutical Technology School of PharmacyUniversity of JordanAmman 11180Jordan Critical Care King Khalid University HospitalKing Saud University Medical CityRiyadh 11362Saudi Arabia Department of Acute Medicine Wirral University Teaching Hospital NHS Foundation TrustArrowe Park HospitalWirralMerseyside CH495PEUnited Kingdom

BACKGROUND Fluoroquinolones are a class of broad-spectrum antimicrobials used for various bacterial infections.Frequent use of fluoroquinolones has been questioned due to severe associated adverse effects,including dysglycemia(hypoglycemia or hyperglycemia)due to an alternation in glucose metabolism.Recent clinical trials showed the association of poor clinical outcomes with hypoglycemia in critically ill patients without diabetes.Many predisposing factors worsen fluoroquinolone-induced hypoglycemia,including diabetes,concomitant medication use like sulfonylureas or insulin,renal disease,and the elderly.CASE SUMMARY We report a case of recurrent hypoglycemia after ciprofloxacin initiation for a 71-year-old,non-diabetic,critically ill patient despite the presence of total parenteral nutrition and nasogastric tube feeding.The adverse drug reaction probability(Naranjo)scale was completed with a probable adverse drug reaction.The hypoglycemia resolved entirely after ciprofloxacin discontinuation.CONCLUSION Although ciprofloxacin-induced hypoglycemia is rare,special consideration is needed for the elderly due to their higher susceptibility to adverse side effects.

关键词： Ciprofloxacin hypoglycemia Fluoroquinolones Total parenteral nutrition Side effect Case report