J Korean Diabetes.  2013 Jun;14(2):83-86. 10.4093/jkd.2013.14.2.83.

Hyperinsulinemic Hypoglycemia After Roux-en-Y Gastric Bypass

• Ha J
• Park J

• KMID: 1430836
• DOI: http://doi.org/10.4093/jkd.2013.14.2.83

Abstract

Bariatric surgery is one of the most efficient ways to achieve weight loss and reduce the complications associated with obesity. Severe hypoglycemia can occur after bariatric surgery, though it is rare. Hypoglycemic episodes have so far been poorly studied and the pathophysiology of hypoglycemia has not yet been demonstrated. Currently, there are two different hypotheses; the first is that hypoglycemic episodes are secondary to hyperinsulinemia and result from beta-cell hyperplasia or hyperfunction. The second is that the primary problem is beta-cell failure, which allows glucose concentrations to reach high values. The few therapeutic options that have been validated are also discussed in this study.

Keyword

Hypoglycemia; Bariatric surgery; Hyperinsulinism

MeSH Terms

Bariatric Surgery
Gastric Bypass
Glucose
Hyperinsulinism
Hyperplasia
Hypoglycemia
Obesity
Weight Loss
Glucose

Reference

1. Ritz P, Hanaire H. Post-bypass hypoglycaemia: a review of current findings. Diabetes Metab. 2011; 37:274–81.

2. Vella A, Service FJ. Incretin hypersecretion in postgastric bypass hypoglycaemia-primary problem or red herring? J Clin Endocrinol Metab. 2007; 92:4563–5.

3. Z'graggen K, Guweidhi A, Steffen R, Potoczna N, Biral R, Walther F, Komminoth P, Horber F. Severe recurrent hypoglycaemia after gastric bypass surgery. Obes Surg. 2008; 18:981–8.

4. Won JG, Tseng HS, Yang AH, Tang KT, Jap TS, Lee CH, Lin HD, Burcus N, Pittenger G, Vinik A. Clinical features and morphological characterization of 10 patients with non insulinoma pancreatogenous hypoglycaemia syndrome (NIPHS). Clin Endocrinol (Oxf). 2006; 65:566–78.

5. Kellogg TA, Bantle JP, Leslie DB, Redmond JB, Slusarek B, Swan T, Buchwald H, Ikramuddin S. Postgastric bypass hyperinsulinemic hypoglycaemia syndrome: characterization and response to a modified diet. Surg Obes Relat Dis. 2008; 4:492–9.

6. SGoldfine AB, Mun EC, Devine E, Bernier R, Baz-Hecht M, Jones DB, Schneider BE, Holst JJ, Patti ME. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. J Clin Endocrinol Metab. 2007; 92:4678–85.

7. Marsk R, Jonas E, Rasmussen F, Naslund E. Nationwide cohort study of postgastric bypass hypoglycaemia including 5,040 patients undergoing surgery for obesity in 1986-2006 in Sweden. Diabetologia. 2010; 53:2307–11.

8. Peterli R, Wölnerhanssen B, Peters T, Devaux N, Kern B, Christoffel-Courtin C, Drewe J, von Flüe M, Beglinger C. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009; 250:234–41.

9. Vidal J, Nicolau J, Romero F, Casamitjana R, Momblan D, Conget I, Morínigo R, Lacy AM. Long-term effects of Roux-en-Y gastric bypass surgery on plasma glucagon-like peptide-1 and islet function in morbidly obese subjects. J Clin Endocrinol Metab. 2009; 94:884–91.

10. Rodieux F, Giusti V, D'Alessio DA, Suter M, Tappy L. Effects of gastric bypass and gastric banding on glucose kinetics and gut hormone release. Obesity (Silver Spring). 2008; 16:298–305.

11. SLaferrère B, Teixeira J, McGinty J, Tran H, Egger JR, Colarusso A, Kovack B, Bawa B, Koshy N, Lee H, Yapp K, Olivan B. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab. 2008; 93:2479–85.

12. Le Roux CW, Aylwin SJ, Batterham RL, Borg CM, Coyle F, Prasad V, Shurey S, Ghatei MA, Patel AG, Bloom SR. Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg. 2006; 243:108–14.

13. Morínigo R, Moizé V, Musri M, Lacy AM, Navarro S, Marín JL, Delgado S, Casamitjana R, Vidal J. Glucagon-like peptide-1, peptide YY, hunger, and satiety after gastric bypass surgery in morbidly obese subjects. J Clin Endocrinol Metab. 2006; 91:1735–40.

14. Kim SH, Liu TC, Abbasi F, Lamendola C, Morton JM, Reaven GM, McLaughlin TL. Plasma glucose and insulin regulation is abnormal following gastric bypass surgery with or without neuroglycopenia. Obes Surg. 2009; 19:1550–6.

15. Patti ME, McMahon G, Mun EC, Bitton A, Holst JJ, Goldsmith J, Hanto DW, Callery M, Arky R, Nose V, Bonner-Weir S, Goldfine AB. Severe hypoglycaemia postgastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia. Diabetologia. 2005; 48:2236–40.

16. Mathavan VK, Arregui M, Davis C, Singh K, Patel A, Meacham J. Management of postgastric bypass non insulinoma pancreatogenous hypoglycaemia. Surg Endosc. 2010; 24:2547–55.

17. Alvarez GC, Faria EN, Beck M, Girardon DT, Machado AC. Laparoscopic spleen-preserving distal pancreatectomy as treatment for nesidioblastosis after gastric bypass surgery. Obes Surg. 2007; 17:550–2.

18. Hanaire H, Dubet A, Chauveau ME, Anduze Y, Fernandes M, Melki V, Ritz P. Usefulness of continuous glucose monitoring for the diagnosis of hypoglycaemia after a gastric bypass in a patient previously treated for type 2 diabetes. Obes Surg. 2010; 20:126–9.

19. Moreira RO, Moreira RB, Machado NA, Goncalves TB, Coutinho WF. Post-prandial hypoglycaemia after bariatric surgery: pharmacological treatment with verapamil and acarbose. Obes Surg. 2008; 18:1618–21.

20. Guseva N, Phillips D, Mordes JP. Successful treatment of persistent hyperinsulinemic hypoglycaemia with nifedipine in an adult patient. Endocr Pract. 2010; 16:107–11.

21. Clancy TE, Moore FD Jr, Zinner MJ. Postgastric bypass hyperinsulinism with nesidioblastosis: subtotal or total pancreatectomy may be needed to prevent recurrent hypoglycemia. J Gastrointest Surg. 2006; 10:1116–9.