[Rare cases] ACEi causes rare hypoglycemia | ENDO2021

Author: Medical team doctors report NMT NMT ENDO compile reports, please do not reprint without authorization.

Introduction: Angiotensin-converting enzyme (ACE) inhibitors are the most commonly used antihypertensive drugs for diabetic patients.

At the 2021 annual meeting of the American Endocrine Society (ENDO), some scholars reported a rare side effect of ACEi drugs-hypoglycemia.

 ACEi is a common antihypertensive drug used to treat patients with diabetes and hypertension.

Many studies have reported that angiotensin-converting enzyme inhibitors can increase the risk of hypoglycemia in diabetic patients, but this patient has no history of diabetes.

 Case introduction The patient, 79 years old, with a background of hypertension, was previously treated with ramipril and Bendroflumethiazide.
He was admitted to the hospital due to hypoglycemia and impaired renal function due to slow response.
The cause has not been confirmed.

After 7 weeks, the patient developed similar symptoms with severe hypoglycemia.

 Relevant clinical parameters at admission: blood glucose (capillary) 1.
9mmol/L, brain CT showed no acute lesions, GCS score 14 points (out of 15 points), after discontinuing all drugs including ACEi, perform OGTT under close supervision , OGTT showed no hypoglycemia.

Since then, hypoglycemia has not occurred again, and the patient was discharged safely.

Follow-up was followed and there was no hypoglycemia 6 months after discharge.
Since the incident occurred 3 years ago, he has never been hospitalized due to hypoglycemia.

 Case Discussion 1.
Triad of Hypoglycemia and Whipple ➤Symptoms of hypoglycemia; ➤Glucose <3.
9mmol/L; ➤Symptoms relieved after taking glucose.

 Checking the literature, a total of 13 cases of ACEi-related hypoglycemia events were recorded, of which 9 cases occurred in diabetic patients, and the rest occurred in non-diabetic patients.

In 1985, the first non-diabetic patient was recorded due to hypoglycemia caused by the use of captopril.

 2.
The mechanism of ACEi causing hypoglycemia ➤The kininogen kinin system has undergone changes related to hypoglycemia; ➤Increase insulin sensitivity; ➤Increase the uptake of glucose by muscle tissue; ➤Down-regulate liver glucose through bradykinin-mediated pathways Generate; ➤Muscle vasodilation.

 Exacerbating factors include concurrent renal damage, as shown in this example.

Moreover, regardless of whether it is accompanied by diabetes, chronic kidney disease is an important risk factor for hypoglycemic events, and this risk is greatest for patients with diabetes.

 Case enlightenment The author suggests that if the patient has unexplained hypoglycemia, it is recommended to consider the possibility of hypoglycemia caused by ACEi if a number of factors cannot be ruled out.