Abnormal glucose tolerance testing after gastric bypass

Hypoglycemia after Roux-En-Y gastric bypass: detection rates of continuous glucose monitoring (CGM) versus mixed meal test

“…Goldfine et al [7] found a high incidence of hypoglycemia in a series of 21 RYGB patients tested by a liquid MMT. Other authors used an OGTT to provoke hypoglycemia with detection rates from 68% [19] to 72% [6]. We were able to show that even in patients with normal provocation tests such as an MMT, hypoglycemic episodes were observed in a 120 hour GCM.…”

“…As with former gastric ulcer surgery procedures, symptomatic post-gastric bypass hypoglycemia usually develops in the later postoperative course [18]. At that point, hypoglycemia might be the main trigger for significant weight regain [19] after a Roux-en-Y gastric bypass due to blood glucose level fluctuations. To address late development of hypoglycemia after RYGB, we included patients with a mean follow-up of 86 months (range 64-107 mo) in this study.…”

The rationale for a duodenal switch as the primary surgical treatment of advanced type 2 diabetes mellitus and metabolic disease

“…Medical weight loss emphases reduced insulin fluctuations, but the most common surgical procedures promote these fluctuations. The effect of oral glucose tolerance testing on RYGB has been previously tested by our group [26]. We demonstrated that abnormal glucose tolerance was extremely common and that more than 80% of patients tested had reactive hypoglycemia.…”

“…An increasing number of reports have shown that RYGB results in hyper-insulinemic hypoglycemia [26,27]. In fact, entities, such as the noninsulinoma-pancreatogenous syndrome and nesidioblastosis after RYGB, have been the subject of an increasing number of publications [28,29].…”

Why it matters. A paired editorial for “Hypoglycemia after Roux-en-Y gastric bypass: detection rates of continuous glucose monitoring (CGM) versus mixed meal test”

“…Initially, we reported that abnormal glucose tolerance was common after RYGB [11]. Rather than halting carbohydrate intake, we suggested that hypoglycemia might cause intermeal hunger and fatigue that encourages snacking and increased caloric consumption.…”