Endocrine Abstracts

Post–bariatric surgery hypoglycaemia (PBH) is a metabolic complication of bariatric surgery. Symptoms of post-bariatric hyperinsulinaemic hypoglycaemia may develop from 6 months to years after surgery, and typically present 1 to 3 hours after a meal. The incidence of post bariatric hypoglycaemia is estimated to be 0.2–11%,^1,4 but the actual incidence is unknown due to the vague symptoms and lack of diagnostic criteria for the diagnosis of post-bariatric hypoglycaemia. To make a definitive diagnosis of post-bariatric hyperinsulinaemic hypoglycaemia, a patient must have symptoms, laboratory values that support the diagnosis and the symptoms must be relieved by carbohydrate ingestion (Whipple’s triad). The management of PBH includes dietary modification (less carbohydrate and more protein) and pharmacotherapy using calcium channel blockers, alpha-glucosidase inhibitors and somatostatin analogues which are often poorly tolerated. In extreme cases, some patients undergo partial pancreatectomy, which may not resolve hypoglycaemia. With regard to post-bariatric surgery nutrient intake, the American Society of Metabolic and Bariatric Surgery² recommends protein intake of at least 60–80 g/day, while other guidelines suggest 1.5–2.1 g/kg of ideal weight. In our cohort of patients, we will be comparing OGTT and MMT as provocative tests for hypoglycaemia. In addition, we seek to evaluate the effect of high protein meal comprising of 70% protein, 15% carbohydrate and 15% fat on glycaemic indices and gut hormone profile.

References

1. H. Sarwar, W.H. Chapman, J.R. Pender, et al. Hypoglycemia after Roux-en-Y gastric bypass: the BOLD experience. Obes Surg 2014 24 (7) 1120.

2. Dan Eisenberg, Dan E. Azagury, Saber Ghiassi, Brandon T. Grover, D.O., Julie J. Kim. Position Statement on Postprandial Hyperinsulinemic Hypoglycemia after Bariatric Surgery. American Society of Metabolic and Bariatric Surgery. Surgery for Obesity and Related Diseases 2017 13 371–378.

3. Abrahamsson N, Börjesson JL, Sundbom M, Wiklund U, Karlsson FA, Eriksson JW. Gastric bypass reduces symptoms and hormonal responses in hypoglycemia. Diabetes 2016 65 (9) 2667–2675.

4. C.J. Lee, J.M. Clark, M. Schweitzer, et al. Prevalence of and risk factors for hypoglycemic symptoms after gastric bypass and sleeve gastrectomy. Obesity 2015 23 (5) 1079–1084.