Journal of Gastrointestinal Surgery

, Volume 15, Issue 10, pp 1879–1888

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

Review Article

DOI: 10.1007/s11605-011-1585-8

Cite this article as:
Cui, Y., Elahi, D. & Andersen, D.K. J Gastrointest Surg (2011) 15: 1879. doi:10.1007/s11605-011-1585-8

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.

Keywords

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

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Yunfeng Cui
    • 1
    • 2
  • Dariush Elahi
    • 3
  • Dana K. Andersen
    • 1
  1. 1.Department of Surgery, Johns Hopkins Bayview Medical CenterJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of MedicineTianjin Medical UniversityTianjinChina
  3. 3.Department of Internal MedicineUniversity of Pennsylvania School of MedicinePhiladelphiaUSA

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