Obesity Surgery

, Volume 18, Issue 12, pp 1618–1621

Post-prandial Hypoglycemia after Bariatric Surgery: Pharmacological Treatment with Verapamil and Acarbose

  • Rodrigo O. Moreira
  • Rustan B. M. Moreira
  • Nikolas A. M. Machado
  • Tatiana B. Gonçalves
  • Walmir F. Coutinho
Case Report


Postprandial hypoglycemia is a common complication of bariatric surgery. It is usually caused by late dumping syndrome, but a few other causes have already been described, including insulinoma and noninsulinoma pancreatogenous hypoglycemic syndrome (NIPHS). Considering that NIPHS is a recently described syndrome and is also very rare, therapeutic approaches are still not consensual. We report the case of a 26-year-old woman who was submitted to bariatric surgery and presented episodic postprandial hypoglycemic episodes after 16 months. Fasting C-peptide, insulin, and glucose were normal. Because of the possibility of NIPHS, clinical treatment was initiated with verapamil and acarbose, leading to a significant reduction of hypoglycemic episodes and also their severity. Surgery is the most common approach to NIPHS. However, in cases of mild or moderate symptoms, it is important to consider the possibility of pharmacological treatment. This approach may result, at least for some time, in an amelioration of symptoms without the need of an aggressive procedure.


Noninsulinoma pancreatogenous hypoglycemic syndrome Obesity surgery Postprandial hypoglycemia Verapamil Acarbose 


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Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Rodrigo O. Moreira
    • 1
    • 4
    • 5
  • Rustan B. M. Moreira
    • 2
  • Nikolas A. M. Machado
    • 3
  • Tatiana B. Gonçalves
    • 2
  • Walmir F. Coutinho
    • 1
    • 4
  1. 1.Obesity and Eating Disorders Group (GOTA)Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione (IEDE)/Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB)Rio de JaneiroBrazil
  2. 2.Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione (IEDE)Rio de JaneiroBrazil
  3. 3.Programa de Saúde da Família (PSF) do Jardim LeblonBelo HorizonteBrazil
  4. 4.Pontifícia Universidade Católica do Rio de Janeiro (PUC-RJ)Rio de JaneiroBrazil
  5. 5.Instituto Estadual de Diabetes e EndocrinologiaRio de JaneiroBrazil

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