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Postgastric bypass hyperinsulinemic hypoglycemia syndrome: characterization and response to a modified diet.
Surg Obes Relat Dis. 2008 Jul-Aug; 4(4):492-9.SO

Abstract

BACKGROUND

Some alarming cases of hypoglycemic episodes in patients who have undergone Roux-en-Y gastric bypass have been reported. The syndrome of hyperinsulinemic hypoglycemia with nesidioblastosis after Roux-en-Y gastric bypass has been previously reported and is controversial. It has been suggested that subtotal or total pancreatectomy might be needed to control the symptoms in these patients. We have identified a similar cohort of patients with hyperinsulinemic hypoglycemia for whom we have reviewed patient characteristics and measured the glucose and insulin response to mixed meals.

METHODS

We reviewed the charts of 14 patients identified by clinic follow-up who reported episodes consistent with hyperinsulinemic hypoglycemia (lightheadedness or loss of consciousness after a high-carbohydrate meal). All patients were given a mixed meal consisting of high carbohydrates on day 1 and a low-carbohydrate meal on day 2. The plasma glucose and serum insulin levels were measured before (fasting) and 30, 60, 90, 120, 150, and 180 minutes after the meal.

RESULTS

After a high-carbohydrate meal, 12 of 14 patients demonstrated hyperglycemia associated with hyperinsulinemia at 30 minutes. These patients subsequently became hypoglycemic while the serum insulin was rapidly declining. After reaching a nadir at 120 minutes, the plasma glucose level corrected spontaneously. After a low-carbohydrate mixed meal, the patients demonstrated very little change in plasma glucose and only a modest increase in serum insulin. Of the 12 patients treated with a low-carbohydrate diet, 6 had substantive symptom improvement, and 10 exhibited at least some improvement.

CONCLUSION

The hyperinsulinemic hypoglycemia noted in some patients after Roux-en-Y gastric bypass has many similarities to the dumping syndrome. A low-carbohydrate diet successfully improved symptoms in most of our patients. Approaches to treatment should involve a low-carbohydrate diet and alpha-glucosidase inhibitors rather than pancreatectomy.

Authors+Show Affiliations

Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18656831

Citation

Kellogg, Todd Andrew, et al. "Postgastric Bypass Hyperinsulinemic Hypoglycemia Syndrome: Characterization and Response to a Modified Diet." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 4, no. 4, 2008, pp. 492-9.
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.
Kellogg, T. A., Bantle, J. P., Leslie, D. B., Redmond, J. B., Slusarek, B., Swan, T., Buchwald, H., & Ikramuddin, S. (2008). Postgastric bypass hyperinsulinemic hypoglycemia syndrome: characterization and response to a modified diet. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 4(4), 492-9. https://doi.org/10.1016/j.soard.2008.05.005
Kellogg TA, et al. Postgastric Bypass Hyperinsulinemic Hypoglycemia Syndrome: Characterization and Response to a Modified Diet. Surg Obes Relat Dis. 2008 Jul-Aug;4(4):492-9. PubMed PMID: 18656831.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Postgastric bypass hyperinsulinemic hypoglycemia syndrome: characterization and response to a modified diet. AU - Kellogg,Todd Andrew, AU - Bantle,John P, AU - Leslie,Daniel B, AU - Redmond,James B, AU - Slusarek,Bridget, AU - Swan,Therese, AU - Buchwald,Henry, AU - Ikramuddin,Sayeed, PY - 2007/06/01/received PY - 2008/04/15/revised PY - 2008/05/02/accepted PY - 2008/7/29/pubmed PY - 2008/10/22/medline PY - 2008/7/29/entrez SP - 492 EP - 9 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 4 IS - 4 N2 - BACKGROUND: Some alarming cases of hypoglycemic episodes in patients who have undergone Roux-en-Y gastric bypass have been reported. The syndrome of hyperinsulinemic hypoglycemia with nesidioblastosis after Roux-en-Y gastric bypass has been previously reported and is controversial. It has been suggested that subtotal or total pancreatectomy might be needed to control the symptoms in these patients. We have identified a similar cohort of patients with hyperinsulinemic hypoglycemia for whom we have reviewed patient characteristics and measured the glucose and insulin response to mixed meals. METHODS: We reviewed the charts of 14 patients identified by clinic follow-up who reported episodes consistent with hyperinsulinemic hypoglycemia (lightheadedness or loss of consciousness after a high-carbohydrate meal). All patients were given a mixed meal consisting of high carbohydrates on day 1 and a low-carbohydrate meal on day 2. The plasma glucose and serum insulin levels were measured before (fasting) and 30, 60, 90, 120, 150, and 180 minutes after the meal. RESULTS: After a high-carbohydrate meal, 12 of 14 patients demonstrated hyperglycemia associated with hyperinsulinemia at 30 minutes. These patients subsequently became hypoglycemic while the serum insulin was rapidly declining. After reaching a nadir at 120 minutes, the plasma glucose level corrected spontaneously. After a low-carbohydrate mixed meal, the patients demonstrated very little change in plasma glucose and only a modest increase in serum insulin. Of the 12 patients treated with a low-carbohydrate diet, 6 had substantive symptom improvement, and 10 exhibited at least some improvement. CONCLUSION: The hyperinsulinemic hypoglycemia noted in some patients after Roux-en-Y gastric bypass has many similarities to the dumping syndrome. A low-carbohydrate diet successfully improved symptoms in most of our patients. Approaches to treatment should involve a low-carbohydrate diet and alpha-glucosidase inhibitors rather than pancreatectomy. SN - 1550-7289 UR - https://www.unboundmedicine.com/medline/citation/18656831/Postgastric_bypass_hyperinsulinemic_hypoglycemia_syndrome:_characterization_and_response_to_a_modified_diet_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(08)00522-4 DB - PRIME DP - Unbound Medicine ER -