TY - JOUR
T1 - Postprandial hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass
T2 - an update
AU - Øhrstrøm, Caroline Christfort
AU - Worm, Dorte
AU - Hansen, Dorte Lindqvist
N1 - Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - 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.
AB - 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.
KW - Biomarkers
KW - Blood Glucose/metabolism
KW - Female
KW - Gastric Bypass/adverse effects
KW - Glucagon-Like Peptide 1/metabolism
KW - Humans
KW - Hyperinsulinism/diagnosis
KW - Hypoglycemia/diagnosis
KW - Insulin/metabolism
KW - Male
KW - Monitoring, Ambulatory
KW - Obesity, Morbid/blood
KW - Postoperative Complications/blood
KW - Postprandial Period
KW - Risk Factors
KW - Sex Factors
U2 - 10.1016/j.soard.2016.09.025
DO - 10.1016/j.soard.2016.09.025
M3 - Review
C2 - 27865808
SN - 1550-7289
VL - 13
SP - 345
EP - 351
JO - Surgery for Obesity and Related Diseases
JF - Surgery for Obesity and Related Diseases
IS - 2
ER -
