Skip to main content
SpringerLink
Log in

Post-Gastric Bypass Hypoglycemia: Diagnosis and Management

  • Chapter
  • First Online:
Bariatric Surgery Complications and Emergencies

Abstract

Roux-en-Y gastric bypass (RYGB) results in significant changes in glucose regulatory mechanisms that are beneficial to most patients, especially those with type 2 diabetes. However, in a small proportion of RYGB patients, these changes can lead to symptomatic postprandial hyperinsulinemic hypoglycemia. This chapter details a diagnostic strategy and options for nonsurgical and surgical treatment of this condition.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract. 2005;20(5):517–25.

    Article  PubMed  Google Scholar 

  2. Ceppa EP, Ceppa DP, Omotosho PA, et al. Algorithm to diagnose etiology of hypoglycemia after Roux-en-Y gastric bypass for morbid obesity: case series and review of the literature. Surg Obes Relat Dis. 2012;8(5):641–7.

    Article  PubMed  Google Scholar 

  3. Choudhary P, Teh MM, Amiel SA. Methods of assessment of counterregulation to hypoglycaemia. In: Roden M, editor. Clinical diabetes research: methods and techniques. Hoboken, NJ: John Wiley & Sons, Ltd.; 2007.

    Google Scholar 

  4. Kellogg TA, Bantle JP, Leslie DB, et al. Postgastric bypass hyperinsulinemic hypoglycemia syndrome: characterization and response to a modified diet. Surg Obes Relat Dis. 2008;4(4):492–9.

    Article  PubMed  Google Scholar 

  5. Service FJ, Natt N, Thompson GB, et al. Noninsulinoma pancreatogenous hypoglycemia: a novel syndrome of hyperinsulinemic hypoglycemia in adults independent of mutations in Kir6.2 and SUR1 genes. J Clin Endocrinol Metab. 1999;84(5):1582–9.

    CAS  PubMed  Google Scholar 

  6. Roslin M, Damani T, Oren J, et al. Abnormal glucose tolerance testing following gastric bypass demonstrates reactive hypoglycemia. Surg Endosc. 2011;25(6):1926–32.

    Article  PubMed  Google Scholar 

  7. Deitel M. The change in the dumping syndrome concept. Obes Surg. 2008;18(12):1622–4.

    Article  PubMed  Google Scholar 

  8. Sawyers JL. Management of postgastrectomy syndromes. Am J Surg. 1990;159(1):8–14.

    Article  CAS  PubMed  Google Scholar 

  9. Rodieux F, Giusti V, D’Alessio DA, et al. Effects of gastric bypass and gastric banding on glucose kinetics and gut hormone release. Obesity (Silver Spring). 2008;16(2):298–305.

    Article  CAS  Google Scholar 

  10. Mingrone G, Castagneto-Gissey L. Mechanisms of early improvement/resolution of type 2 diabetes after bariatric surgery. Diabetes Metab. 2009;35(6 Pt 2):518–23.

    Article  CAS  PubMed  Google Scholar 

  11. Laferrere B. Do we really know why diabetes remits after gastric bypass surgery? Endocrine. 2011;40(2):162–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Anderwald C-H, Tura A, Promintzer-Schifferl M, et al. Alterations in gastrointestinal, endocrine, and metabolic processes after bariatric Roux-en-Y gastric bypass surgery. Diabetes Care. 2012;35(12):2580–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Caiazzo R, Zerrweck C, Verhaeghe R, et al. Gastric bypass and glucose metabolism. Diabetes Metab. 2009;35(6 Pt 2):528–31.

    Article  CAS  PubMed  Google Scholar 

  14. Korner J, Inabnet W, Conwell IM, et al. Differential effects of gastric bypass and banding on circulating gut hormone and leptin levels. Obesity (Silver Spring). 2006;14(9):1553–61.

    Article  CAS  Google Scholar 

  15. Rubino F, Gagner M, Marescaux J. Surgical treatment of type 2 diabetes mellitus. Lancet. 2001;358(9282):668–9.

    Article  CAS  PubMed  Google Scholar 

  16. Bikman BT, Zheng D, Pories WJ, et al. Mechanism for improved insulin sensitivity after gastric bypass surgery. J Clin Endocrinol Metab. 2008;93(12):4656–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Cummings DE. Gastric bypass and nesidioblastosis—too much of a good thing for islets? N Engl J Med. 2005;353(3):300–2.

    Article  CAS  PubMed  Google Scholar 

  18. Korner J, Inabnet W, Febres G, et al. Prospective study of gut hormone and metabolic changes after adjustable gastric banding and Roux-en-Y gastric bypass. Int J Obes (Lond). 2009;33(7):786–95.

    Article  CAS  Google Scholar 

  19. Baggio LL, Drucker DJ. Biology of incretins: GLP-1 and GIP. Gastroenterology. 2007;132(6):2131–57.

    Article  CAS  PubMed  Google Scholar 

  20. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.

    Article  CAS  PubMed  Google Scholar 

  21. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56.

    Article  PubMed  Google Scholar 

  22. Adams TD, Pendleton RC, Strong MB, et al. Health outcomes of gastric bypass patients compared to nonsurgical, nonintervened severly obese. Obesity (Silver Spring). 2010;18(1):121–30.

    Article  Google Scholar 

  23. Service GJ, Thompson GB, Service FJ, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med. 2005;353(3):249–54.

    Article  CAS  PubMed  Google Scholar 

  24. Clancy TE, Moore FD, Zinner MJ. Post-gastric bypass hyperinsulinism with nesidioblastosis: subtotal or total pancreatectomy may be needed to prevent recurrent hypoglycemia. J Gastrointest Surg. 2006;10(8):1116–9.

    Article  PubMed  Google Scholar 

  25. 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(11):2236–40.

    Article  CAS  PubMed  Google Scholar 

  26. Alvarez GC, Faria EN, Beck M, et al. Laparoscopic spleen-preserving distal pancreatectomy as treatment for nesidioblastosis after gastric bypass surgery. Obes Surg. 2007;17(4):550–2.

    Article  PubMed  Google Scholar 

  27. 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(7):1554–9.

    Article  PubMed  Google Scholar 

  28. Verhaeghe R, Zerrweck C, Hubert T, et al. Gastric bypass increases postprandial insulin and GLP-1 in nonobese minipigs. Eur Surg Res. 2014;52(1–2):41–9.

    CAS  PubMed  Google Scholar 

  29. Salehi M, Prigeon RL, D’Alessio DA. Gastric bypass surgery enhances glucagon-like peptide 1-stimulated postprandial insulin secretion in humans. Diabetes. 2011;60(9):2308–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Korner J, Bessler M, Inabnet W, et al. Exaggerated glucagon-like peptide-1 and blunted glucose-dependent insulinotropic peptide secretion are associated with Roux-en-Y gastric bypass but not adjustable gastric banding. Surg Obes Relat Dis. 2007;2007(3):6.

    Google Scholar 

  31. Rabiee A, Magruder JT, Salas-Carrillo R, et al. Hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass: unraveling the role of gut hormonal and pancreatic endocrine dysfunction. J Surg Res. 2011;2011(167):2.

    Google Scholar 

  32. Lee CJ, Brown T, Magnuson TH, et al. Hormonal response to a mixed-meal challenge after reversal of gastric bypass for hypoglycemia. J Clin Endocrinol Metab. 2013;98(7):E1208–12.

    Article  CAS  PubMed  Google Scholar 

  33. Laferrere B, Teixeira J, McGinty J, et al. 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(7):2479–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Reubi JC, Perren A, Rehmann R, et al. Glucagon-like peptide (GLP-1) receptors are not overexpressed in pancreatic islets from patients with severe hyperinsulinaemic hypoglycaemia following gastric bypass. Diabetologia. 2010;53(12):2641–5.

    Article  CAS  PubMed  Google Scholar 

  35. Salehi M, Gastaldelli A, D’Alessio DA. Blockage of glucagon-like peptide 1 receptor corrects postprandial hypoglycemia after gastric bypass. Gastroenterology. 2014;146(3):669–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Goldfine AB, Mun EC, Devine E, et al. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. J Clin Endocrinol Metab. 2007;92(12):4678–85.

    Article  CAS  PubMed  Google Scholar 

  37. Campos GM, Rabl C, Peeva S, et al. Improvement in peripheral glucose uptake after gastric bypass surgery is observed only after substantial weight loss has occurred and correlates with the magnitude of weight loss. J Gastrointest Surg. 2010;14(1):15–23.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Patti ME, Goldfine AB. Hypoglycemia after gastric bypass: the dark side of GLP-1. Gastroenterology. 2014;146(3):605–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Davis DB, Khoraki J, Campos GM. Recalcitrant hypoglycemia with neuroglycopenia after Roux-en-Y gastric bypass is caused by postprandial changes in glucose, gut and pancreatic hormone responses to altered feeding route, not nesidioblastosis. Scientific Papers Session. 31st Annual Meeting. American Society for Bariatric and Metabolic Surgery. Boston, MA; 2014.

    Google Scholar 

  40. Campos GM, Ziemelis M, Paparodis R, et al. Laparoscopic reversal of Roux-en-Y gastric bypass: technique and utility for treatment of endocrine complications. Surg Obes Relat Dis. 2014;10(1):36–43.

    Article  PubMed  Google Scholar 

  41. Vilallonga R, van de Vrande S, Himpens J. Laparoscopic reversal of Roux-en-Y gastric bypass into normal anatomy with or without sleeve gastrectomy. Surg Endosc. 2013;27(12):4640–8.

    Article  PubMed  Google Scholar 

  42. 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(3):709–28.

    Article  CAS  PubMed  Google Scholar 

  43. Lev-Ran A, Anderson RW. The diagnosis of postprandial hypoglycemia. Diabetes. 1981;30(12):996–9.

    Article  CAS  PubMed  Google Scholar 

  44. Service FJ. Hypoglycemic disorders. N Engl J Med. 1995;332(17):1144–52.

    Article  CAS  PubMed  Google Scholar 

  45. Mordes JP, Alonso LC. Evaluation, medical therapy, and course of adult persistent hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass surgery: a case series. Endocr Pract. 2014;1–34 (Epub ahead of print).

    Google Scholar 

  46. Scarpignato C. The place of octreotide in the medical management of the dumping syndrome. Digestion. 1996;57 Suppl 1:114–8.

    Article  CAS  PubMed  Google Scholar 

  47. McLoughlin JC, Buchanan KD, Alam MJ. A glycoside-hydrolase inhibitor in treatment of dumping syndrome. Lancet. 1979;314(8143):603–5.

    Article  Google Scholar 

  48. Moreira RO, Moreira RB, Machado NAM, et al. Post-prandial hypoglycemia after bariatric surgery: pharmacological treatment with verapamil and acarbose. Obes Surg. 2008;18(12):1618–21.

    Article  PubMed  Google Scholar 

  49. Arao T, Okada Y, Hirose A, et al. A rare case of adult-onset nesidioblastosis treated successfully with diazoxide. Endocr J. 2006;53(1):95–100.

    Article  PubMed  Google Scholar 

  50. Ritz P, Vaurs C, Bertrand M, et al. Usefulness of acarbose and dietary modifications to limit glycemic variability following Roux-en-Y gastric bypass as assessed by continuous glucose monitoring. Diabetes Technol Ther. 2012;14(8):736–40.

    Article  CAS  PubMed  Google Scholar 

  51. Valderas JP, Ahuad J, Rubio L, et al. Acarbose improves hypoglycaemia following gastric bypass surgery without increasing glucagon-like peptide 1 levels. Obes Surg. 2012;22(4):582–6.

    Article  PubMed  Google Scholar 

  52. Frankhouser SY, Ahmad AN, Perilli GA, et al. Post-gastric-bypass hypoglycemia successfully treated with alpha-glucosidase inhibitor therapy. Endocr Pract. 2013;19(3):511–4.

    Article  PubMed  Google Scholar 

  53. Geer RJ, Richards WO, O’Dorisio TM, et al. Efficacy of octreotide acetate in treatment of severe postgastrectomy dumping syndrome. Ann Surg. 1990;212(6):678–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. de Heide LJ, Laskewitz AJ, Apers JA. Treatment of severe postRYGB hyperinsulinemic hypoglycemia with pasireotide: a comparison with octreotide on insulin, glucagon, and GLP-1. Surg Obes Relat Dis. 2014;10(3):e31–3.

    Article  PubMed  Google Scholar 

  55. Myint KS, Greenfield JR, Farooqi IS, et al. Prolonged successful therapy for hyperinsulinaemic hypoglycaemia after gastric bypass: the pathophysiological role of GLP1 and its response to a somatostatin analogue. Eur J Endocrinol. 2012;166(5):951–5.

    Article  CAS  PubMed  Google Scholar 

  56. Tabibian N. Successful treatment of refractory post-vagotomy syndrome with verapamil (Calan SR). Am J Gastroenterol. 1990;85(3):328–9.

    CAS  PubMed  Google Scholar 

  57. Fernandez-Esparrach G, Lautz DB, Thompson CC. Peroral endoscopic anastomotic reduction improves intractable dumping syndrome in Roux-en-Y gastric bypass patients. Surg Obes Relat Dis. 2010;6(1):36–40.

    Article  PubMed  Google Scholar 

  58. Leitman IM, Virk CS, Avgerinos DV, et al. Early results of trans-oral endoscopic plication and revision of the gastric pouch and stoma following Roux-en-Y gastric bypass surgery. JSLS. 2010;14(2):217–20.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Vanderveen KA, Grant CS, Thompson GB, et al. Outcomes and quality of life after partial pancreatectomy for noninsulinoma pancreatogenous hypoglycemia from diffuse islet cell disease. Surgery. 2010;148(6):1237–45.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Himpens J, Dapri G, Cadiere GB. Laparoscopic conversion of the gastric bypass into a normal anatomy. Obes Surg. 2006;16(7):908–12.

    Article  PubMed  Google Scholar 

  61. Dapri G, Cadiere GB, Himpens J. Laparoscopic reconversion of Roux-en-Y gastric bypass to original anatomy: technique and preliminary outcomes. Obes Surg. 2011;21(8):1289–95.

    Article  PubMed  Google Scholar 

  62. Campos GM, Jablons D, Brown LM, Ramirez RM, et al. A safe and reproducible anastomotic technique for minimally invasive Ivor Lewis oesophagectomy: the circular-stapled anastomosis with the trans-oral anvil. Eur J Cardiothorac Surg. 2010;37(6):1421–6.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Mix CL. “Dumping stomach” following gastrojejunostomy. Surg Clin North Am. 1922;2:617–22.

    Google Scholar 

  64. Banerjee A, Ding Y, Mikami DJ, et al. The role of dumping syndrome in weight loss after gastric bypass surgery. Surg Endosc. 2013;27(5):1573–8.

    Article  PubMed  Google Scholar 

  65. Lips MA, de Groot GH, van Klinken JB, et al. Calorie restriction is a major determinant of the short-term metabolic effects of gastric bypass surgery in obese type 2 diabetic patients. Clin Endocrinol (Oxf). 2014;80(6):834–42.

    Article  CAS  Google Scholar 

  66. Isbell JM, Tamboli RA, Hansen EN, et al. The importance of caloric restriction in the early improvements in insulin sensitivity after Roux-en-Y gastric bypass surgery. Diabetes Care. 2010;33(7):1438–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Lingvay I, Guth E, Islam A, et al. Rapid improvement in diabetes after gastric bypass surgery: is it the diet or surgery? Diabetes Care. 2013;36(9):2741–7.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Swarbrick MM, Stanhope KL, Austrheim-Smith IT, et al. Longitudinal changes in pancreatic and adipocyte hormones following Roux-en-Y gastric bypass surgery. Diabetologia. 2008;51(10):1901–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Olbers T, Bjorkman S, Lindroos A, et al. Body composition, dietary intake, and energy expenditure after laparoscopic Roux-en-Y gastric bypass and laparoscopic vertical banded gastroplasty: a randomized clinical trial. Ann Surg. 2006;244(5):715–22.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Tamboli RA, Hossain HA, Marks PA, et al. Body composition and energy metabolism following Roux-en-Y gastric bypass surgery. Obesity (Silver Spring). 2010;18(9):1718–24.

    Article  CAS  Google Scholar 

  71. Miller GD, Carr JJ, Fernandez AZ. Regional fat changes following weight reduction from laparoscopic Roux-en-Y gastric bypass surgery. Diabetes Obes Metab. 2011;13(2):189–92.

    Article  CAS  PubMed  Google Scholar 

  72. Immonen H, Hannukainen JC, Iozzo P, et al. Effect of bariatric surgery on liver glucose metabolism in morbidly obese diabetic and non-diabetic patients. J Hepatol. 2014;60(2):377–83.

    Article  CAS  PubMed  Google Scholar 

  73. Lin E, Phillips LS, Ziegler TR, et al. Increases in adinopectin predict improved liver, but not peripheral, insulin sensitivity in severly obese women during weight loss. Diabetes. 2007;56(3):735–42.

    Article  CAS  PubMed  Google Scholar 

  74. Malin SK, Bena J, Abood B, et al. Attenuated improvements in adinopectin and fat loss characterize type 2 diabetes non-remission status after bariatric surgery. Diabetes Obes Metab. 2014;16(12):1230–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  75. Geloneze B, Tambascia MA, Pareja JC, et al. Serum leptin levels after bariatric surgery across a range of glucose tolerance from normal to diabetes. Obes Surg. 2001;11(6):693–8.

    Article  CAS  PubMed  Google Scholar 

  76. Camastra S, Gastaldelli A, Mari A, et al. Early and longer term effects of gastric bypass surgery on tissue-specific insulin sensitivity and beta cell function in morbidly obese patients with and without type 2 diabetes. Diabetologia. 2011;54(8):2093–102.

    Article  CAS  PubMed  Google Scholar 

  77. Dunn JP, Abumrad NN, Breitman I, et al. Hepatic and peripheral insulin sensitivity and diabetes remission at 1 month after Roux-en-Y gastric bypass surgery in patients randomized to omentectomy. Diabetes Care. 2012;35(1):137–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Bojsen-Moller KN, Dirksen C, Jorgensen NB, et al. Increased hepatic insulin clearance after Roux-en-Y gastric bypass. J Clin Endocrinol Metab. 2013;98(6):E1066–71.

    Article  PubMed  Google Scholar 

  79. Bojsen-Moller KN, Dirksen C, Jorgensen NB, et al. Early enhancements of hepatic and later of peripheral insulin sensitivity combined with increased postprandial insulin secretion contribute to improved glycemic control after Roux-en-Y gastric bypass. Diabetes. 2014;63(5):1725–37.

    Article  PubMed  Google Scholar 

  80. Nannipieri M, Baldi S, Colligiani D, et al. Roux-en-Y gastric bypass and sleeve gastrectomy: mechanisms of diabetes remission and role of gut hormones. J Clin Endocrinol Metab. 2013;98(11):4391–9.

    Article  CAS  PubMed  Google Scholar 

  81. Thaler JP, Cummings DE. Minireview: hormonal and metabolic mechanisms of diabetes remission after gastrointestinal surgery. Endocrinology. 2009;150(6):2518–25.

    Article  CAS  PubMed  Google Scholar 

  82. Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346(21):1623–30.

    Article  PubMed  Google Scholar 

  83. Umeda LM, Silva EA, Carneiro G, et al. Early improvement in glycemic control after bariatric surgery and its relationships with insulin, GLP-1, and glucagon secretion in type 2 diabetic patients. Obes Surg. 2011;21(7):896–901.

    Article  PubMed  Google Scholar 

  84. Kashyap SR, Daud S, Kelly KR, et al. Acute effects of gastric bypass versus gastric restrictive surgery on beta-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes. Int J Obes (Lond). 2010;34(3):462–71.

    Article  CAS  Google Scholar 

  85. Weiss R. Effects of Roux-en-Y gastric bypass on β-cell function. Diabetes. 2014;63(4):1171–3.

    Article  CAS  PubMed  Google Scholar 

  86. Ferrannini E, Mingrone G. Impact of different bariatric surgical procedures on insulin action and beta-cell function in type 2 diabetes. Diabetes Care. 2009;32(3):514–20.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Rabl C, Rao MN, Schwarz JM, et al. Thermogenic changes after gastric bypass, adjustable gastric banding or diet alone. Surgery. 2014;156(4):806–12.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Das SK, Roberts SB, McCrory MA, et al. Long-term changes in energy expenditure and body composition after massive weight loss induced by gastric bypass surgery. Am J Clin Nutr. 2003;78(1):22–30.

    CAS  PubMed  Google Scholar 

  89. Liou AP, Paziuk M, Luevano JM, Machineni S, et al. Conserved shifts in the gut microbiota due to gastric bypass reduce host weight and adiposity. Sci Transl Med. 2013;5(178):178ra41.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Vrieze A, Van Nood E, Holleman F, et al. Transfer of intestinal microbiota from lean donors increases insulin sensitivity in individuals with metabolic syndrome. Gastroenterology. 2012;143(4):913–6.

    Article  CAS  PubMed  Google Scholar 

  91. Sweeney TE, Morton JM. Metabolic surgery: action via hormonal milieu changes, changes in bile acids or gut microbiota? A summary of the literature. Best Pract Res Clin Gastroenterol. 2014;28(4):727–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Patti ME, Houten SM, Bianco AC, et al. Serum bile acids are higher in humans with prior gastric bypass: potential contribution to improved glucose and lipid metabolism. Obesity (Silver Spring). 2009;17(9):1671–7.

    Article  CAS  Google Scholar 

  93. Pournaras DJ, Glicksman C, Vincent RP, et al. The role of bile after Roux-en-Y gastric bypass in promoting weight loss and improving glycaemic control. Endocrinology. 2012;153(8):3613–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. Carswell KA, Vincent RP, Belgaumkar AP, et al. The effect of bariatric surgery on intestinal absorption and transit time. Obes Surg. 2014;24(5):796–805.

    Article  PubMed  Google Scholar 

  95. Campos GM, Ziemelis M, Paparodis R, Ahmed M, Davis DB. Laparoscopic reversal of Roux-en-Y gastric bypass: technique and utility for treatment of endocrine complications. Surg Obes Relat Dis. 2014;10(1):36–43. doi:10.1016/j.soard.2013.05.012. Epub 2013 Jun 29.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Laura E. Fischer MD, MS & Jad Khoraki MD

  2. Department of Medicine, Division of Endocrinology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Dawn Belt-Davis MD

  3. Department of Surgery, Division of Bariatric and Gastrointestinal Surgery, Virginia Commonwealth University Medical Center, 980519, Richmond, 23298-0519, VA, USA

    Guilherme M. Campos MD, FACS, FASMBS

Authors
  1. Laura E. Fischer MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dawn Belt-Davis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jad Khoraki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guilherme M. Campos MD, FACS, FASMBS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guilherme M. Campos MD, FACS, FASMBS .

Editor information

Editors and Affiliations

  1. Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA

    Daniel M. Herron

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Fischer, L.E., Belt-Davis, D., Khoraki, J., Campos, G.M. (2016). Post-Gastric Bypass Hypoglycemia: Diagnosis and Management. In: Herron, D. (eds) Bariatric Surgery Complications and Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-27114-9_21

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-27114-9_21

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27112-5

  • Online ISBN: 978-3-319-27114-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation