Hypoglycemia is induced by many causes, especially over-dose of
insulin or oral
hypoglycemic agents in diabetic subjects. In such a case, hyperinsulinemic
hypoglycemia is usually observed. On the other hand, it is important to classify secondary
hypoglycemia and hypoinsulinemic
hypoglycemia. Liver injury-induced
hypoglycemia is one of the causes of hypoinsulinemic
hypoglycemia but rarely observed in clinical practice. Herein, we experienced similar 2 cases of non-diabetic hypoinsulinemic
hypoglycemia. Both of them were elderly subjects with low
body weight. Furthermore, it is likely that hypoinsulinemic
hypoglycemia in both subjects was triggered by severe liver injury, at least in part, due to possible limited
liver glycogen store. In elderly subjects with low
body weight and/or
malnutrition, metabolism in the liver is reduced and
glycogen accumulation is decreased. Such alteration brings out acute and marked liver injury, which finally leads to the onset of severe
hypoglycemia. It is known that not only liver injury but also
multiple organ failure could be induced due to extreme
emaciation in subjects. It is likely that in elderly subjects with low
body weight and/or
malnutrition,
multiple organ failure including
liver failure could be induced due to the similar reason. Therefore, we should be very careful of such subjects in order to avoid the development of
multiple organ failure which leads to life-threatening situations. In conclusion, we should keep in mind the possibility of hypoinsulinemic
hypoglycemia when we examine severe liver injury, especially in elderly or starving subjects with low
body weight and limited
liver glycogen stores.
LEARNING POINTS: It is important to classify secondary
hypoglycemia and hypoinsulinemic
hypoglycemia.Liver injury-induced
hypoglycemia is one of the causes of hypoinsulinemic
hypoglycemia but rarely observed in everyday clinical practice.Herein, we reported similar 2 cases of hypoinsulinemic
hypoglycemia without diabetes presumably triggered by severe liver injury.In both cases,
hypoglycemia was improved by
glucose infusion, although their liver injury was not improved.We should keep in mind the possibility of hypoinsulinemic
hypoglycemia when we examine severe liver injury, especially in elderly subjects with low
body weight.