As obesity and type II diabetes increases worldwide, so has bariatric procedures with over 200,000 procedures performed in 2014 alone in the US.   Roux-en-Y gastric bypass (RYGB) surgeries, comprising over one-third of all bariatric procedures, involves creating a stomach pouch out of the stomach and attaching it directly to the small intestine, bypassing a large part of the stomach and duodenum.  This results in the loss of over 60% excess body weight, and resolves diabetes in 85% of individuals.

However, as the use of bariatric surgical procedures increases worldwide, a post-surgical condition due to excessive glucagon-like peptide – 1 (GLP-1) secretion resulting in hyperinsulinemic hypoglycemia is increasingly reported in 5-10% of RYGB patients.  This disorder leads to frequent symptomatic hypoglycemia, often resulting in glucose concentrations low enough to cause seizures, altered mental status, loss of consciousness, cognitive dysfunction, disability and death.  Quality of life can be severely diminished, and many patients cannot care for themselves or others, work, drive, or be left alone.  While mild cases of hyperinsulinemic hypoglycemia can be managed with dietary carbohydrate restriction, moderate-to-severe cases are refractory, and medications (e.g. octreotide, diazoxide, verapamil, acarbose) have both poor efficacy and tolerability.

There is no effective treatment for severe hypoglycaemia associated with bariatric surgery.

Hypoglycemia Induced in Two Forms of Bariatric Surgery:
Vertical Sleeve Gastrectomy (A) and Roux-En-Y (B)

Bypass Types

Post-bariatric Hypoglycemia