Gastric Bypass pp 307-313 | Cite as

Hypoglycemia After Gastric Bypass

  • Glauco da Costa Alvarez


Hypoglycemia after Roux-en-Y gastric bypass is a rare and challenging condition. It occurs several months to years after surgery and has been more commonly seen in females. Severe hypoglycemia presents with symptoms of the Whipple’s triad that include signs as perspiration, palpitations, hunger, fatigue, confusion, aggression, tremor, syncope, a low plasma glucose concentration, and resolution of those symptoms after carbohydrate intake. Specific symptoms of hypoglycemia are categorized as autonomic or neuroglycopenic. Autonomic symptoms include anxiety, sweating, tremors, and palpitation. Neuroglycopenic symptoms comprehend confusion, weakness, light-headedness, dizziness, blurred vision, disorientation, and eventually, loss of consciousness, coma, and death.

When the patient is symptomatic, a fasting plasma glucose <50 mg/dl with serum insulin level is the first step for the decision-making process. Hyperinsulinemia is a condition in which the insulin level is above 6 mμU/ml and C-peptide elevated >5 ng/ml. A proinsulin level <5 pmol/L is a highly sensitive clue on eliminating insulinoma as a cause of endogenous hyperinsulinemia. The mixed meal tolerance test (MMTT) is the preferred provocative test. Most patients with post-RYGB hypoglycemia benefit from dietary restrictions or more complex nutritional and medical management strategies, including acarbose, nifedipine, diazoxide, GLP-1 receptor antagonist, and octreotide.

If the response is not adequate, surgery may be considered to alleviate the symptoms. Gastrostomy tube placement and/or addition of restriction, before reversal of the RYGB have been used as alternatives. Partial pancreatectomies are indicated only in exceptional cases.


Postprandial hyperinsulinemic hypoglycemia Hypoglycemia-like Hyperinsulinemia Nesidioblastosis RYGB Dumping syndrome Distal pancreatectomy Morbid obesity Glucagon-like peptide 1 Bariatric surgery 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Glauco da Costa Alvarez
    • 1
  1. 1.Department of SurgeryFederal University of Santa MariaSanta MariaBrazil

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