Hypoglycemia After Gastric Bypass Surgery

Abstract

Severe hypoglycemia characterized by neuroglycopenic symptoms is a recently described and relatively uncommon complication of gastric bypass surgery. It occurs several months to years after surgery and may be distinct from the more commonly encountered dumping syndrome that occurs early in the postoperative course and usually improves with time. Nesidioblastosis has been proposed as a possible underlying mechanism for late postoperative hypoglycemia. This syndrome is distinct from noninsulinoma pancreatogenous hypoglycemia and likely has a multifactorial etiology. It responds variably to nutrition and pharmacological interventions. Partial pancreatectomy and reversal of the bypass have sometimes been used to ameliorate symptoms.

Endocrine and metabolic complications after bariatric surgery

“…Additionally, selective arterial calcium-stimulation test is employed as the last step in the evaluation of these patients to localize the area of hypersecretion. [ 64 ]…”

Non-pharmacological Treatment Options in the Management of Diabetes Mellitus

“…However, the presence of neuroglycopaenic features is often associated with PBH, which helps suspicion of this condition in patients. 66 Carbohydrate-restricted diet, increased consumption of dietary fibres and avoidance of alcohol helps to reduce the incidence of PBH. 66 – 68 Drugs such as acarbose, diazoxide, octreotide and verapamil are useful in treating PBH.…”

“… 66 Carbohydrate-restricted diet, increased consumption of dietary fibres and avoidance of alcohol helps to reduce the incidence of PBH. 66 – 68 Drugs such as acarbose, diazoxide, octreotide and verapamil are useful in treating PBH. 67 , 68 Restoring gastric restriction with an adjustable band, placing the gastrostomy tube and subtotal or total pancreatectomy are proposed as surgical treatment options for severe intractable PBH.…”

Hypoglycemia associated with non-islet cell tumors

“…According to the review of this topic by de Groot et al [6] 41% are represented by mesenchymal tumors, 43% by tu-mors of epithelial origin, 1% of tumors with neuroendocrine and hematopoietic origin and 14% of unknown origin [6,7]. However the review of recent reported cases of NICTH identified variety of pathologic diagnoses and widespread anatomic locations of tumors associated with paraneoplastic hypoglycemia [7,8].…”