title: Recognition and management of hyperinsulinemic hypoglycemia after bariatric surgery.
abstract: Hyperinsulinemic hypoglycemia with neuroglycopenia is an increasingly recognized complication of Roux-en-Y gastric bypass (RYGB) due to the changes in gut hormonal milieu. Physicians should be aware of this complication to ensure timely and effective treatment of post-RYGB patients, who present to them with hypoglycemic symptoms. Possible causes of hypoglycemia in these patients include late dumping syndrome, nesidioblastosis and rarely insulinoma. Systematic evaluation including history, biochemical analysis, and diagnostic testing might help in distinguishing among these diagnoses. Continuous glucose monitoring is also a valuable tool, revealing the episodes in the natural environment and can also be used to monitor treatment success. Treatment should begin with strict low carbohydrate diet, followed by medication therapy. Therapy with diazoxide, acarbose, calcium channel blockers and octreotide have been proven to be beneficial, but the response apparently is highly variable. When other treatment options fail, surgical options can be considered.
authors.affiliation: Neuropsychiatric Research Institute, Fargo, ND, United States; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States.
authors.forename: Sarah
authors.initials: S
authors.lastname: Malik
authors.affiliation: Neuropsychiatric Research Institute, Fargo, ND, United States; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States. Electronic address: jmitchell@nrifagro.com.
authors.forename: James E
authors.initials: JE
authors.lastname: Mitchell
authors.affiliation: Neuropsychiatric Research Institute, Fargo, ND, United States; North Dakota State University, United States.
authors.forename: Kristine
authors.initials: K
authors.lastname: Steffen
authors.affiliation: Neuropsychiatric Research Institute, Fargo, ND, United States; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States.
authors.forename: Scott
authors.initials: S
authors.lastname: Engel
authors.affiliation: Sanford Health, Fargo, ND, United States.
authors.forename: Ron
authors.initials: R
authors.lastname: Wiisanen
authors.affiliation: Sanford Health, Fargo, ND, United States.
authors.forename: Luis
authors.initials: L
authors.lastname: Garcia
authors.affiliation: University of North Dakota School of Medicine and Health Sciences, Fargo, ND, United States.
authors.forename: Shahbaz Ali
authors.initials: SA
authors.lastname: Malik
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects*; D006801:Humans; D006946:Hyperinsulinism / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D007003:Hypoglycemia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D009767:Obesity, Morbid / Q000601:surgery
keywords: Bariatric surgery; Dumping syndrome; Glucagon like peptide-1 (GLP-1); Hypoglycemia; Nesidioblastosis