title: Postprandial hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass: an update.
abstract: Roux-en-Y gastric bypass (RYGB) is an efficient treatment for morbid obesity and reduces obesity-related co-morbidities. With the growing number of patients undergoing gastric bypass, complications now demand further attention. Postprandial hyperinsulinemic hypoglycemia (PHH) after Roux-en-Y gastric bypass is a complex condition, characterized by increased glucose variability including both hyperglycemic and hypoglycemic values. PHH seems to be more prevalent than previously suggested and is highly dependent on the choice of diagnostic tool, which has not yet been standardized. Questionnaires, an oral glucose tolerance test, a mixed meal tolerance test, and continuous glucose monitoring have been used, each with their own advantages. The condition is further complicated by a large group of asymptomatic cases. Patients with symptoms of PHH after gastric bypass are characterized by exaggerated insulin and glucagon-like peptide-1 responses compared to asymptomatic operated patients. The counter-regulatory mechanisms responsible for preventing hypoglycemia appear to be altered. The cause of these changes is not entirely understood, and it remains difficult to identify patients at risk of developing hypoglycemia. Known risk factors are female sex, longer time since surgery, and lack of prior diabetes. Management of the hypoglycemic episodes is difficult, and only dietary modifications consisting of frequent and less carbohydrate-rich meals seem to be efficient. Medical treatments and surgical procedures have been attempted in few studies and still warrant further examination.
authors.affiliation: Department of Medicine, Zealand University Hospital, Køge, Denmark. Electronic address: cacg@regionsjaelland.dk.
authors.forename: Caroline Christfort
authors.initials: CC
authors.lastname: Øhrstrøm
authors.affiliation: Department of Medicine, Amager Hospital, Denmark.
authors.forename: Dorte
authors.initials: D
authors.lastname: Worm
authors.affiliation: Steno Diabetes Center, Gentofte, Denmark.
authors.forename: Dorte Lindqvist
authors.initials: DL
authors.lastname: Hansen
mesh_terms: D015415:Biomarkers; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism; D006801:Humans; D006946:Hyperinsulinism / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D007003:Hypoglycemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D007328:Insulin / Q000378:metabolism; D008297:Male; D018670:Monitoring, Ambulatory; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery*; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000628:therapy; D019518:Postprandial Period; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin; D052216:Glucagon-Like Peptide 1
keywords: Continuous glucose monitoring; Gastric bypass; Hyperinsulinemia; Hypoglycemia