Diagnosis and management of post-bariatric surgery hypoglycemia

ABSTRACT

Introduction

While bariatric surgery remains the most effective treatment for obesity that allows substantial weight loss with improvement and possibly remission of obesity-associated comorbidities, some postoperative complications may occur. Managing physicians need to be familiar with the common problems to ensure timely and effective management. Of these complications, postoperative hypoglycemia is an increasingly recognized complication of bariatric surgery that remains underreported and underdiagnosed.

Area covered

This article highlights the importance of identifying hypoglycemia in patients with a history of bariatric surgery, reviews pathophysiology and addresses available nutritional, pharmacological and surgical management options. Systemic evaluation including careful history taking, confirmation of hypoglycemia and biochemical assessment is essential to establish accurate diagnosis. Understanding the weight-dependent and weight-independent mechanisms of improved postoperative glycemic control can provide better insight into the causes of the exaggerated responses that lead to postoperative hypoglycemia.

Expert opinion

Management of post-operative hypoglycemia can be challenging and requires a multidisciplinary approach. While dietary modification is the mainstay of treatment for most patients, some patients may benefit from pharmacotherapy (e.g. GLP-1 receptor antagonist); Surgery (e.g. reversal of gastric bypass) is reserved for unresponsive severe cases. Additional research is needed to understand the underlying pathophysiology with a primary aim in optimizing diagnostics and treatment options.

KEYWORDS:

• Bariatric surgery
• gastric bypass
• hypoglycemia
• GLP-1
• hyperinsulinemia

Article highlights

• Diagnosis of hypoglycemia post-bariatric surgery

• Pathophysiology of hypoglycemia post-bariatric surgery

• Nutritional management of hypoglycemia post-bariatric surgery

• Pharmacological management of hypoglycemia post-bariatric surgery

• Surgical management of hypoglycemia post-bariatric surgery

Declaration of interest

W Scott Butsch is consultant for Novo Nordisk, and an advisor for Abbott and Alfie. Sangeeta Kashyap is on the steering committee for Fractyl Laboratories, GI Dynamics, and is a contract Chief Medical Officer for Gila Therapeutics. Previously, she obtained research funding from Janssen, Covidien, and Ethicon. Ali Aminian has received research funding and speaking honorarium from Medtronic and Ethicon. Other authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.