Postprandial hypoglycemia after gastric bypass surgery: From pathogenesis to diagnosis and treatment

Henri Honka, Marzieh Salehi

Research output: Contribution to journalReview article

1 Scopus citations

Abstract

Purpose of reviewThe Roux-en-Y gastric bypass surgery (RYGB) improves glucose control in majority of patients with type 2 diabetes. However, a minority group of individuals develop a life-threatening complication of hyperinsulinemic hypoglycemia. The goal of this review is to identify underlying mechanisms by which RYGB cause hypoglycemia and describe pathogenesis-driven strategies to diagnose and treat this condition.Recent findingsGastric bypass leads to higher and earlier peak levels of glucose and lower nadir glucose after eating along with larger insulin and glucagon-like peptide 1 (GLP-1) secretion, resetting the balance between glucose appearance and clearance after this procedure. These weight-loss independent glycemic effects of RYGB have been attributed to changes in ingested glucose appearance as a result of rapid nutrient emptying from stomach pouch to the intestine and increased glucose clearance as a result of prandial hyperinsulinemia. The exaggerated effect of RYGB on postmeal glucose metabolism is a syndrome of postprandial hyperinsulinemic hypoglycemia manifesting in a group of individuals several years after this surgery. Affected patients have larger systemic appearance of ingested glucose and greater postmeal secretion of insulin and GLP-1 compared to those with history of RYGB without symptomatic hypoglycemia. Current evidence supporting a multifactorial model of glucose dysregulation among patients with hypoglycemia will be highlighted in this review.SummaryHypoglycemia after RYGB is a life-threatening condition and likely represents the extreme glycemic phenotype of this procedure. Diagnosis is challenging and treatment options are limited.

Original languageEnglish (US)
Pages (from-to)295-302
Number of pages8
JournalCurrent opinion in clinical nutrition and metabolic care
Volume22
Issue number4
DOIs
StatePublished - Jul 1 2019
Externally publishedYes

Keywords

  • counterregulatory response
  • gastric bypass surgery
  • glucose kinetics
  • hypoglycemia
  • islet-cell function

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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