title: Effect of carbohydrate restriction in patients with hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Hyperinsulinemic hypoglycemia is a rare complication of Roux-en-Y gastric bypass (RYGB) surgery. Meals with a high carbohydrate (carb) content and high glycemic index (GI) may provoke these hypoglycemic attacks. The aim of this study is to assess the effects of reducing meal carb content and GI on glycemic responses in patients with post-RYGB hypoglycemia.
  
  
  METHODS
  Fourteen patients with post-RYGB hypoglycemia underwent two meal tests: a mixed meal test (MMT) with a carb content of 30 g and a meal test with the low GI supplement, Glucerna SR 1.5® (Glucerna meal test (GMT)). Plasma glucose and serum insulin levels were measured for a period of 6 h.
  
  
  RESULTS
  Peak glucose levels were reached at T 30 during GMT and at T 60 during MMT, and they were 1.5 ± 0.3 mmol/L lower during GMT than during MMT (7.5 ± 0.4 vs 9.0 ± 0.4 mmol/L, P < 0.005). GMT induced the most rapid rise in plasma insulin: at T 30 plasma, insulin was 30.7 ± 8.5 mU/L higher during GMT than during MMT (P < 0.005). None of the carb-restricted meals induced post-prandial hypoglycemia.
  
  
  CONCLUSIONS
  A 30-g carb-restricted meal may help to prevent post-prandial hypoglycemia in patients with post-RYGB hypoglycemia. The use of a liquid, low GI, supplement offers no additional advantage.
authors.affiliation: Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, 6800 TA, Arnhem, The Netherlands.
authors.forename: Nadia
authors.initials: N
authors.lastname: Botros
authors.forename: Iris
authors.initials: I
authors.lastname: Rijnaarts
authors.forename: Hans
authors.initials: H
authors.lastname: Brandts
authors.forename: Gysele
authors.initials: G
authors.lastname: Bleumink
authors.forename: Ignace
authors.initials: I
authors.lastname: Janssen
authors.forename: Hans
authors.initials: H
authors.lastname: de Boer
mesh_terms: D000328:Adult; D001786:Blood Glucose; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000178:diet therapy / Q000209:etiology*; D007328:Insulin / Q000097:blood; D008297:Male; D062407:Meals; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007328:Insulin