文/余宜叡
![](https://1.bp.blogspot.com/-sbNibcC-EAw/YRjE_oXW8vI/AAAAAAAERbI/yHRbJ8jETmsuioKHZWisPIPoZ3WM9t8ewCNcBGAsYHQ/s16000/%25E8%2588%2587%25E7%25B3%2596%25E5%2585%25B1%25E8%2588%259E_%25E7%25B3%2596%25E5%25B0%25BF%25E7%2597%2585_%25E6%25B8%259B%25E9%2587%258D_%25E4%25BD%2599%25E5%25AE%259C%25E5%258F%25A1_%25E5%25B7%25A5%25E4%25BD%259C%25E5%259D%258A_%25E9%2596%2580%25E8%25A8%25BA_%25E7%25B7%259A%25E4%25B8%258A_%25E5%25AD%25B8%25E7%25BF%2592_%25E5%2580%258B%25E6%25A1%2588_%25E8%2587%25A8%25E5%25BA%258A_%25E8%2583%2583%25E8%25BC%2595%25E7%2599%25B1.PNG)
「胰島素對此類型的患者,會是比較好的選擇」
「藥物的增減,需做整體的考量」
「留意胃輕癱的鑑別診斷」
![](https://1.bp.blogspot.com/-abznmDXt0Po/YRjE_jwLFVI/AAAAAAAERbE/Fkk6PyShoAgeWnrFlNP6yYC7ZGDYmdelACNcBGAsYHQ/s16000/%25E8%2588%2587%25E7%25B3%2596%25E5%2585%25B1%25E8%2588%259E_%25E7%25B3%2596%25E5%25B0%25BF%25E7%2597%2585_%25E6%25B8%259B%25E9%2587%258D_%25E4%25BD%2599%25E5%25AE%259C%25E5%258F%25A1_%25E5%25B7%25A5%25E4%25BD%259C%25E5%259D%258A_%25E9%2596%2580%25E8%25A8%25BA_%25E7%25B7%259A%25E4%25B8%258A_%25E5%25AD%25B8%25E7%25BF%2592_%25E5%2580%258B%25E6%25A1%2588_%25E8%2587%25A8%25E5%25BA%258A_%25E8%2583%2583%25E8%25BC%2595%25E7%2599%25B1_02.PNG)
治療選擇
從個案帶到今天要分享的重點。胰島素對此類型的患者,會是比較好的選擇,後續的胰島素轉換是另一個學習重點。此個案也印證,長期控糖不佳的併發症會一一發生…後續漫長且麻煩的治療,會是不小的醫療負擔,同時也影響生活品質甚多。
![](https://1.bp.blogspot.com/-VCDSNIOw6wg/YRjE_jw-CwI/AAAAAAAERbM/11q-i9Mj6yYiWtEgJgjpigX-XxZ_7dpVACNcBGAsYHQ/s16000/%25E8%2588%2587%25E7%25B3%2596%25E5%2585%25B1%25E8%2588%259E_%25E7%25B3%2596%25E5%25B0%25BF%25E7%2597%2585_%25E6%25B8%259B%25E9%2587%258D_%25E4%25BD%2599%25E5%25AE%259C%25E5%258F%25A1_%25E5%25B7%25A5%25E4%25BD%259C%25E5%259D%258A_%25E9%2596%2580%25E8%25A8%25BA_%25E7%25B7%259A%25E4%25B8%258A_%25E5%25AD%25B8%25E7%25BF%2592_%25E5%2580%258B%25E6%25A1%2588_%25E8%2587%25A8%25E5%25BA%258A_%25E8%2583%2583%25E8%25BC%2595%25E7%2599%25B1_03.PNG)
藥物增減
臨床實務上,metformin還是第一線用藥,若因胃輕癱的關係,減少metformin的使用劑量,是否會影響到血糖的控制?若血糖控制不佳,是不是會造成胃輕癱變嚴重?因此metformin的藥物的增減,需做整體的考量,不是說不用就不用,說減就減,而類似的情況也發生在延緩胃排空的腸泌素身上。
![](https://1.bp.blogspot.com/-k-_BzwI6AO4/YRjFAbXOjuI/AAAAAAAERbQ/xqkppBgNAekkJeCkryICkCCHsq2eS-h6wCNcBGAsYHQ/s16000/%25E8%2588%2587%25E7%25B3%2596%25E5%2585%25B1%25E8%2588%259E_%25E7%25B3%2596%25E5%25B0%25BF%25E7%2597%2585_%25E6%25B8%259B%25E9%2587%258D_%25E4%25BD%2599%25E5%25AE%259C%25E5%258F%25A1_%25E5%25B7%25A5%25E4%25BD%259C%25E5%259D%258A_%25E9%2596%2580%25E8%25A8%25BA_%25E7%25B7%259A%25E4%25B8%258A_%25E5%25AD%25B8%25E7%25BF%2592_%25E5%2580%258B%25E6%25A1%2588_%25E8%2587%25A8%25E5%25BA%258A_%25E8%2583%2583%25E8%25BC%2595%25E7%2599%25B1_04.PNG)
Keep in mind
餐後1-2個小時內易發生低血糖,就要留意胃輕癱的鑑別診斷。柯醫師提醒,若是高度懷疑的話,要轉給腸胃科醫師做診治。最應謝謝主辦單位與柯醫師的整理,對於胃輕癱與糖尿病重點溫故知新,用心整理了許多相關論文與研究,雖然胃輕癱發生率不高,但還是要心中要有這個診斷。
![](https://1.bp.blogspot.com/-gEnO-SCiOec/YRjFAi_uGeI/AAAAAAAERbU/7fgFexLu62AaUarwqr46LBSGVXbgD5wNgCNcBGAsYHQ/s16000/%25E8%2588%2587%25E7%25B3%2596%25E5%2585%25B1%25E8%2588%259E_%25E7%25B3%2596%25E5%25B0%25BF%25E7%2597%2585_%25E6%25B8%259B%25E9%2587%258D_%25E4%25BD%2599%25E5%25AE%259C%25E5%258F%25A1_%25E5%25B7%25A5%25E4%25BD%259C%25E5%259D%258A_%25E9%2596%2580%25E8%25A8%25BA_%25E7%25B7%259A%25E4%25B8%258A_%25E5%25AD%25B8%25E7%25BF%2592_%25E5%2580%258B%25E6%25A1%2588_%25E8%2587%25A8%25E5%25BA%258A_%25E8%2583%2583%25E8%25BC%2595%25E7%2599%25B1_05.PNG)
早期介入
早期診斷與治療,有其必要。越是瞭解糖尿病,越是知道糖尿病是影響全身、降低生活品質的疾病,如:胃輕癱…早期介入,有效控糖,可以減少相關併發症的發生。