title: Advances in the etiology and management of hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA.
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Cui
authors.forename: Dariush
authors.initials: D
authors.lastname: Elahi
authors.forename: Dana K
authors.initials: DK
authors.lastname: Andersen
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism* / Q000628:therapy; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D006946:Hyperinsulinism / Q000209:etiology* / Q000378:metabolism / Q000628:therapy; D007003:Hypoglycemia / Q000209:etiology* / Q000378:metabolism / Q000628:therapy; D009765:Obesity / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D015431:Weight Loss / Q000502:physiology