Postprandial hyperinsulinemic hypoglycemia after bariatric surgery

Authors

  • María Graciela Álvarez Center for the Study and Treatment of Severe Obesity, Autonomous City of Buenos Aires, Argentina
  • Susana Gutt Italian Hospital of Buenos Aires, Autonomous City of Buenos Aires, Argentina
  • María Yuma Italian Hospital of Buenos Aires, Autonomous City of Buenos Aires, Argentina
  • Paola Polo San José Hospital of the City of Campana; Las Lomas Sanatorium, Province of Buenos Aires, Argentina
  • Sandra González Diabetes Clinic, IMA Clinic, Adrogué, Province of Buenos Aires, Argentina
  • Estrella Menéndez Center of Medical Education and Clinical Research "Norberto Quirno" (CEMIC), Autonomous City of Buenos Aires, Argentina
  • Guadalupe Vanoli General Hospital of Agudos "José María Ramos Mejía", Province of Buenos Aires, Argentina
  • Hugo Montemerlo Sanatorio Mater Dei, Autonomous City of Buenos Aires, Argentina
  • Marianela Ackerman Integral Center of Endocrinology and Nutrition (CIEN), Corrientes, Argentina
  • Jimena Coronel Maffei Medical Center, Autonomous City of Buenos Aires, Argentina
  • Carla Gauna Medical Scientific Liason Diabetes and Obesity, Novo Nordisk, Autonomous City of Buenos Aires, Argentina
  • María Victoria Salinas Center of Medical Education and Clinical Investigations "Norberto Quirno" (CEMIC), Autonomous City of Buenos Aires, Argentina
  • Carla Musso Favaloro Foundation, Care Unit "César Milstein", National Institute of Social Services for Retirees and Pensioners, Autonomous City of Buenos Aires, Argentina
  • Juliana Mociulsky Buenos Aires Cardiovascular Institute, Autonomous City of Buenos Aires, Argentina
  • Susana Fuentes El Cruce Hospital, Comprehensive Medical Care Service for the Community (SAMIC), Province of Buenos Aires, Argentina

DOI:

https://doi.org/10.47196/diab.v53i1.137

Keywords:

hyperinsulinemic hypoglycemia, postprandial hypoglycemia, bariatric surgery, gastric bypass, late dumping

Abstract

Associated with the obesity epidemic and the growing number of bariatric surgery procedures being performed worldwide, the incidence of reported complications has increased as well. Among these, the postprandial hyperinsulinemic hypoglycemia (PHH) warrants further attention. This condition is not entirelly understood and is probably underdiagnosed. The PHH is characterized by hypoglycemic symptoms occurring after a meal accompanied by a low plasma glucose value, typically preceded by a high rise in both glucose and insulin concentrations. Patients with PHH have shown increased glucose variability with a rapid increase in glucose absorption into the systemic circulation and an increase in glucose disappearance, with glucose values reaching both the hyperglycemic and hypoglycemic areas. It should be suspected in patients with postprandial adrenergic or neuroglycopenic symptoms after bariatric surgery1.

It was considered most commonly associated with Roux-en Y gastric bypass (RYGB), although it was also described after biliopancreatic diversion (BPD), BPD with duodenal switch2, sleeve gastrectomy, and other surgical procedures which compromises the pylorus and the gastric emptying3. It has not been observed after adjustable gastric banding, an intervention that does not alter the gastrointestinal anatomy4-5.

Author Biographies

María Graciela Álvarez, Center for the Study and Treatment of Severe Obesity, Autonomous City of Buenos Aires, Argentina

Nutrition specialist; Coordinator of the Center for the Study and Treatment of Severe Obesity

Susana Gutt, Italian Hospital of Buenos Aires, Autonomous City of Buenos Aires, Argentina

Medical Specialist in Nutrition; Head of the Section Nutrition Medical Clinic Service, Italian Hospital of Buenos Aires

María Yuma, Italian Hospital of Buenos Aires, Autonomous City of Buenos Aires, Argentina

Medical Specialist in Nutrition; Master in Diabetes; Plant Physician, Nutrition Section, Medical Clinic Service, Italian Hospital of Buenos Aires

Paola Polo, San José Hospital of the City of Campana; Las Lomas Sanatorium, Province of Buenos Aires, Argentina

Endocrinologist, Sanatorio Las Lomas; Staff Physician of the Endocrinology Service, San José Hospital in the City of Campana

Sandra González, Diabetes Clinic, IMA Clinic, Adrogué, Province of Buenos Aires, Argentina

Doctor

Estrella Menéndez, Center of Medical Education and Clinical Research "Norberto Quirno" (CEMIC), Autonomous City of Buenos Aires, Argentina

Medical Specialist in Nutrition; Plant Physician of the Nutrition and Diabetes Service, Center of Medical Education and Clinical Research "Norberto Quirno" (CEMIC)

Guadalupe Vanoli, General Hospital of Agudos "José María Ramos Mejía", Province of Buenos Aires, Argentina

Medical specialist in Nutrition; Plant Physician of the Nutrition and Diabetes Unit of the General Hospital of Agudos "José María Ramos Mejía"

Hugo Montemerlo, Sanatorio Mater Dei, Autonomous City of Buenos Aires, Argentina

Medical specialist in Internal Medicine and specialist in Nutrition

Marianela Ackerman, Integral Center of Endocrinology and Nutrition (CIEN), Corrientes, Argentina

Medical Specialist in Internal Medicine and Nutrition, Master in Diabetes

Jimena Coronel, Maffei Medical Center, Autonomous City of Buenos Aires, Argentina

Medical specialist in Internal Medicine

Carla Gauna, Medical Scientific Liason Diabetes and Obesity, Novo Nordisk, Autonomous City of Buenos Aires, Argentina

Medical specialist in Medical Clinic and Nutrition

María Victoria Salinas, Center of Medical Education and Clinical Investigations "Norberto Quirno" (CEMIC), Autonomous City of Buenos Aires, Argentina

Medical specialist in Clinic and Nutrition, member of the Department of Medical Clinic and Nutrition, Center of Medical Education and Clinical Investigations "Norberto Quirno" (CEMIC)

Carla Musso, Favaloro Foundation, Care Unit "César Milstein", National Institute of Social Services for Retirees and Pensioners, Autonomous City of Buenos Aires, Argentina

Endocrinologist; Diabetes Coordinator, Favaloro Foundation; Staff Doctor of the "César Milstein" Care Unit, National Institute of Social Services for Retirees and Pensioners (INSSJP)

Juliana Mociulsky, Buenos Aires Cardiovascular Institute, Autonomous City of Buenos Aires, Argentina

Endocrinologist, Head of the Nutrition Unit, Buenos Aires Cardiovascular Institute

Susana Fuentes, El Cruce Hospital, Comprehensive Medical Care Service for the Community (SAMIC), Province of Buenos Aires, Argentina

Medical specialist in Internal Medicine; Medical Hospital "El Cruce", Comprehensive Medical Care Service for the Community (SAMIC)

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Published

2023-01-10

How to Cite

Álvarez, M. G., Gutt, S., Yuma, M., Polo, P., González, S., Menéndez, E., Vanoli, G., Montemerlo, H., Ackerman, M., Coronel, J., Gauna, C., Salinas, M. V., Musso, C., Mociulsky, J., & Fuentes, S. (2023). Postprandial hyperinsulinemic hypoglycemia after bariatric surgery. Journal of the Argentine Society of Diabetes, 53(1), 16–27. https://doi.org/10.47196/diab.v53i1.137