Obesity Surgery

, Volume 22, Issue 4, pp 582–586

Acarbose Improves Hypoglycaemia Following Gastric Bypass Surgery Without Increasing Glucagon-Like Peptide 1 Levels

  • Juan Patricio Valderas
  • Jessica Ahuad
  • Lorena Rubio
  • Manuel Escalona
  • Felipe Pollak
  • Alberto Maiz
Clinical Research



Postprandial hypoglycaemia is a severe complication of Roux-en-Y gastric bypass (RYGBP). Acarbose, an α-glucosidase inhibitor (AGI), is employed in its treatment. Several studies have shown that AGIs increase the postprandial levels of glucagon-like peptide 1 (GLP-1). However, an excessive level of GLP-1 is one of the factors involved in the physiopathology of this condition. We analysed the effect of acarbose oral administration in eight RYBGP patients with clinically significant hypoglycaemia or dumping syndrome.


Glucose, insulin and GLP-1 plasma levels in fasting and after ingestion of a standard meal (Ensure Plus®; 13 g protein, 50 g carbohydrate, 11 g fat) were measured. The test was repeated the following week with the oral administration of 100 mg of acarbose 15 min prior to the meal.


Five patients developed asymptomatic hypoglycaemia during the test (glucose level <50 mg/dl) with inappropriately high insulin levels and exaggerated GLP-1 response. Acarbose ingestion avoided hypoglycaemia in all of the patients and increased the lowest plasma glucose level (46.4 ± 4.8 vs. 59.0 ± 2.6 mg/dl, p < 0.01). Acarbose ingestion decreased the area under the curve for serum insulin and GLP-1 levels at 15 min after the meal.


Acarbose avoided postprandial hypoglycaemia following RYGBP by decreasing the hyperinsulinemic response. This was associated with a decrease in early GLP-1 secretion, in contrast to that observed in non-surgical subjects. This finding could be explained by the reduction of glucose load in the jejunum produced by the α-glucosidase inhibition, which is the main stimulus for GLP-1 secretion.


Glucagon-like peptide 1 Acarbose Hypoglycaemia Gastric bypass 


  1. 1.
    Marsk R, Jonas E, Rasmussen F, et al. Nationwide cohort study of post-gastric bypass hypoglycaemia including 5,040 patients undergoing surgery for obesity in 1986–2006 in Sweden. Diabetologia. 2010;53:2307–11.PubMedCrossRefGoogle Scholar
  2. 2.
    Vella A, Service FJ. Incretin hypersecretion in post-gastric bypass hypoglycemia—primary problem or red herring? J Clin Endocrinol Metab. 2007;92:4563–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Patti ME, McMahon G, Mun EC, et al. Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia. Diabetologia. 2005;48:2236–40.PubMedCrossRefGoogle Scholar
  4. 4.
    Moreira RO, Moreira RB, Machado NA, et al. Post-prandial hypoglycemia after bariatric surgery: pharmacological treatment with verapamil and acarbose. Obes Surg. 2008;18:1618–21.PubMedCrossRefGoogle Scholar
  5. 5.
    Godbout A, Chiasson JL. Who should benefit from the use of alpha-glucosidase inhibitors? Curr Diab Rep. 2007;7:333–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Radziuk J, Kemmer F, Morishima T, et al. The effects of an alpha-glucoside hydrolase inhibitor on glycemia and the absorption of sucrose in man determined using a tracer method. Diabetes. 1984;33:207–13.PubMedCrossRefGoogle Scholar
  7. 7.
    Seifarth C, Bergmann J, Holst JJ, et al. Prolonged and enhanced secretion of glucagon-like peptide 1 (7-36) after oral sucrose due to alpha-glucosidase inhibition (acarbose) in type 2 diabetes patients. Diabet Med. 1998;15:154–63.CrossRefGoogle Scholar
  8. 8.
    Enc F, Imeryuz N, Akin L, et al. Inhibition of gastric emptying by acarbose is correlated with GLP-1 response and accompanied by CCK release. Am J Physiol Gastrointest Liver Physiol. 2001;281:752–63.Google Scholar
  9. 9.
    Patti ME, Goldfine AB. Hypoglycaemia following gastric bypass surgery—diabetes remission in the extreme? Diabetologia. 2010;53:2276–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Goldfine AB, Mun EC, Devine E, et al. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory response. J Clin Endocrinol Metab. 2007;92:4678–85.PubMedCrossRefGoogle Scholar
  11. 11.
    Valderas JP, Irribarra V, Rubio L, et al. Effects of sleeve gastrectomy and medical treatment for obesity on glucagon-like peptide 1 levels and glucose homeostasis in non-diabetic subjects. Obes Surg. 2011;21:902–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Toft-Nielsen M, Madsbad S, Hoslt JJ. Exaggerated secretion of glucagon-like peptide-1 (GLP-1) could cause reactive hypoglycaemia. Diabetologia. 1998;41:1180–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Imhof A, Schneemann M, Schaffner A, et al. Reactive hypoglycaemia due to late dumping syndrome: successful treatment with acarbose. Swiss Med Wkly. 2001;131:81–3.PubMedGoogle Scholar
  14. 14.
    Nauck M, Vardarli I, Deacon C, et al. Secretion of glucagon-like peptide-1 (GLP-1) in type 2 diabetes: what is up, what is down? Diabetologia. 2011;54:10–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Perfetti R, Zhou J, Doyle ME, et al. Glucagon-like peptide-1 induces cell proliferation and pancreatic-duodenum homeobox-1 expression and increases endocrine cell mass in the pancreas of old, glucose-intolerant rats. Endocrinology. 2000;141:4600–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Service GJ, Thompson GB, Service FJ, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric bypass surgery. N Engl J Med. 2005;353:249–54.PubMedCrossRefGoogle Scholar
  17. 17.
    Meier JJ, Butler AE, Galasso R, et al. Hyperinsulinemic hypoglycemia after gastric bypass surgery is not accompanied by islet hyperplasia or increased beta-cell turnover. Diabetes Care. 2006;29:1554–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Rumilla KM, Erickson LA, Service FJ, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis: histologic features and growth factor expression. Mod Pathol. 2009;22:239–45.PubMedCrossRefGoogle Scholar
  19. 19.
    Hanaire H, Dubet A, Chauveau ME, et al. Usefulness of continuous glucose monitoring for the diagnosis of hypoglycemia after a gastric bypass in a patient previously treated for type 2 diabetes. Obes Surg. 2010;20:126–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Lefèbvre PJ, Andreani D, Marks V, et al. Statement on postprandial a or reactive a hypoglycaemia. Diabetes Care. 1988;1:439.Google Scholar
  21. 21.
    Cryer PE, Axelrod L, Grossman AB, et al. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2009;94:709–28.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2011

Authors and Affiliations

  • Juan Patricio Valderas
    • 1
  • Jessica Ahuad
    • 1
  • Lorena Rubio
    • 1
  • Manuel Escalona
    • 1
  • Felipe Pollak
    • 1
  • Alberto Maiz
    • 1
  1. 1.Department of Nutrition, Diabetes and Metabolism, School of MedicinePontificia Universidad Catolica de ChileSantiagoChile

Personalised recommendations