Recognition and management of hyperinsulinemic hypoglycemia after bariatric surgery

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• 作者：Sarah Malik^a ; ^b ; James E. Mitchell^a ; ^b ; ^{jmitchell@nrifagro.com" class="auth_mail" title="E-mail the corresponding author} ; Kristine Steffen^a ; ^c ; Scott Engel^a ; ^b ; Ron Wiisanen^d ; Luis Garcia^d ; Shahbaz Ali Malik^b
• 关键词：Hypoglycemia ; Bariatric surgery ; Nesidioblastosis ; Dumping syndrome ; Glucagon like peptide-1 (GLP-1)
• 刊名：Obesity Research & Clinical Practice
• 出版年：2016
• 出版时间：January-February 2016
• 年：2016
• 卷：10
• 期：1
• 页码：1-14
• 全文大小：966 K

文摘

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.