Advances in the Etiology and Management of Hyperinsulinemic Hypoglycemia After Roux-en-Y Gastric Bypass

Yunfeng Cui, Dariush Elahi, Dana K. Andersen

Research output: Contribution to journalArticle

50 Scopus citations

Abstract

Introduction: Hyperinsulinemic hypoglycemia with severe neuroglycopenia has been identified as a late complication of Roux-en-Y gastric bypass (RYGB) in a small number of patients. Discussion: The rapid resolution of type 2 diabetes mellitus after RYGB is probably related to increased secretion of the incretin hormones glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1), and patients with post-RYGB hypoglycemia demonstrate prolonged elevations of GIP and GLP-1 compared to non-hypoglycemic post-RYGB patients. Nesidioblastosis has been identified in some patients with post-RYGB hypoglycemia and is likely due to the trophic effects of GIP and GLP-1 on pancreatic islets. Conclusions: Treatment of hypoglycemia after RYGB should begin with strict dietary (low carbohydrate) alteration and may require a trial of diazoxide, octreotide, or calcium-channel antagonists, among other drugs. Surgical therapy should include consideration of a restrictive form of bariatric procedure, with or without reconstitution of gastrointestinal continuity. Partial or total pancreatic resection should be avoided.

Original languageEnglish (US)
Pages (from-to)1879-1888
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume15
Issue number10
DOIs
StatePublished - Oct 1 2011

Keywords

  • Glucagon-like peptide-1 (GLP-1)
  • Glucose-dependent insulinotropic polypeptide (GIP)
  • Hypoglycemia
  • Nesidioblastosis
  • Roux-en-Y gastric bypass

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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