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Hypoglycemia After Gastric Bypass

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Gastric Bypass

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Abstract

Hypoglycemia after Roux-en-Y gastric bypass is a rare and challenging condition. It occurs several months to years after surgery and has been more commonly seen in females. Severe hypoglycemia presents with symptoms of the Whipple’s triad that include signs as perspiration, palpitations, hunger, fatigue, confusion, aggression, tremor, syncope, a low plasma glucose concentration, and resolution of those symptoms after carbohydrate intake. Specific symptoms of hypoglycemia are categorized as autonomic or neuroglycopenic. Autonomic symptoms include anxiety, sweating, tremors, and palpitation. Neuroglycopenic symptoms comprehend confusion, weakness, light-headedness, dizziness, blurred vision, disorientation, and eventually, loss of consciousness, coma, and death.

When the patient is symptomatic, a fasting plasma glucose <50 mg/dl with serum insulin level is the first step for the decision-making process. Hyperinsulinemia is a condition in which the insulin level is above 6 mμU/ml and C-peptide elevated >5 ng/ml. A proinsulin level <5 pmol/L is a highly sensitive clue on eliminating insulinoma as a cause of endogenous hyperinsulinemia. The mixed meal tolerance test (MMTT) is the preferred provocative test. Most patients with post-RYGB hypoglycemia benefit from dietary restrictions or more complex nutritional and medical management strategies, including acarbose, nifedipine, diazoxide, GLP-1 receptor antagonist, and octreotide.

If the response is not adequate, surgery may be considered to alleviate the symptoms. Gastrostomy tube placement and/or addition of restriction, before reversal of the RYGB have been used as alternatives. Partial pancreatectomies are indicated only in exceptional cases.

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Author information

Authors and Affiliations

  1. Department of Surgery, Federal University of Santa Maria, Santa Maria, Brazil

    Glauco da Costa Alvarez

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  1. Glauco da Costa Alvarez
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Editors and Affiliations

  1. UNIME School of Medicine, Salvador, Bahia, Brazil

    João Ettinger

  2. Bahia School of Medicine and Public Health, Salvador, Bahia, Brazil

    Euler Ázaro

  3. Johann Wolfgang Goethe University, Frankfurt, Hessen, Germany

    Rudolf Weiner

  4. Ste 460, Fresno, CA, USA

    Kelvin D. Higa

  5. Gastro Obeso Center Clinic, São Paulo, São Paulo, Brazil

    Manoel Galvão Neto

  6. Orlando Health, Orlando, FL, USA

    Andre Fernandes Teixeira

  7. Orlando Health, Orlando, FL, USA

    Muhammad Jawad

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da Costa Alvarez, G. (2020). Hypoglycemia After Gastric Bypass. In: Ettinger, J., et al. Gastric Bypass. Springer, Cham. https://doi.org/10.1007/978-3-030-28803-7_35

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  • DOI: https://doi.org/10.1007/978-3-030-28803-7_35

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