Postprandial hypoglycemia after gastric bypass surgery

Abstract

Bariatric surgery has proved successful as a treatment option for obesity. Dumping syndrome and postprandial hypoglycemia are among the postoperative risks. The latter often develops several months to years after surgery and in individual cases it may be associated with life-threatening symptoms such as loss of consciousness and seizures. A significant cause is impaired incretin-induced postprandial hyperinsulinemia. Raised preoperative concentrations of insulin-like growth factor 1 (IGF-1) may also be linked to an increased risk of postprandial hypoglycemia. The basis of treatment is intensive dietary supervision, with identification of the triggering foods. Fast-absorbing carbohydrates should generally be avoided. Medications such as acarbose can reduce the postprandial increase in glucose, thus minimizing the stimulus for insulin secretion. Overall, postprandial hypoglycemia has not yet been sufficiently studied; the development of standardized diagnostic tests is urgently required.