Reversible Hyperinsulinemic Hypoglycemia after Gastric Bypass: A Consequence of Altered Nutrient Delivery
Abstract
Context Severe hypoglycemia after Roux-en-Y gastric bypass surgery (RYGB) is an increasingly recognized condition, characterized by neuroglycopenia and inappropriately elevated insulin concentrations that occur primarily in the postprandial state. Both pathophysiology and treatment of this disorder remain elusive, but it has been postulated that hyperplasia and/or hypertrophy of beta-cells due to morbid obesity and/or postsurgical nesidioblastosis may contribute. Objective The objective of this study was to elucidate the pathophysiology of this condition; specifically, we hypothesized that metabolic abnormalities were a function of altered nutrient transit through the gastrointestinal tract rather than anatomical changes to pancreatic beta-cells that would lead to consistently high insulin secretion irrespective of nutrient transit route. DESIGN/SETTING/SUBJECT/OUTCOME MEASURES: We describe a unique case wherein gastrostomy tube (GT) insertion into the remnant stomach reversed neuroglycopenic symptoms. This subject was admitted to a university hospital research center for standardized measurement of glucose, insulin, and incretin hormones including glucagon-like peptide-1, gastric-inhibitory peptide, and glucagon. Results Standardized liquid meal administration via GT vs. oral route demonstrated complete reversal of severe metabolic abnormalities that included hypersecretion of insulin and GLP-1. Conclusion Post-RYGB hyperinsulinemia and hypoglycemia result entirely from alte…
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Restoring the original nutrient transit route via placement of a gastric tube in the remnant stomach was also reported to be effective.
“Restoring the original nutrient transit route via placement of a gastric tube in the remnant stomach was also reported to be effective (127).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [127]
Standardized liquid meal administration via a gastric tube demonstrated complete reversal of severe metabolic abnormalities including hypersecretion of insulin and incretin hormones such as GLP-1 compared with oral administration.
“Standardized liquid meal administration via a gastric tube demonstrated complete reversal of severe metabolic abnormalities including hypersecretion of insulin and incretin hormones such as GLP-1 compared with oral administration (127).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [127]
Enteral nutrition via gastrostomy tube placement in the remnant pouch reduced hypoglycemic symptoms in RYGB case reports.
“In the case of RYGB, case reports have demonstrated that enteral nutrition via gastrostomy tube placement in the remnant pouch reduced hypoglycemic symptoms [68,69].”
From Non-Diabetic Hypoglycemia: Evaluation and Management in Adults (2025) · cites this paper as [68]
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References 25 · Cited by 183
- Authors
- McLaughlin, T., Peck, M., Holst, J., & Deacon, C.
- Affiliations
- Stanford Medicine (US)
- University of Copenhagen (DK)
- Corresponding author
- McLaughlin, Tracey
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2010-04-01
- Volume
- 95
- Issue
- 4
- Pages
- 1851-1855
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2138474841
- Cited by
- 183
- References
- 25
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 2 · 2023: 8 · 2022: 8 · 2021: 4 · 2020: 8 · 2019: 7 · 2018: 13 · 2017: 15 · 2016: 18 · 2015: 16 · 2014: 14 · 2013: 18 · 2012: 15
- FWCI
- 20.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Keywords
- Roux-en-Y gastric bypass, postprandial hypoglycemia, hyperinsulinemia, neuroglycopenia, gastrostomy tube, incretins, glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide, glucagon, nesidioblastosis, morbid obesity, bariatric surgery complications
- MeSH terms
- Adult, Blood Glucose, Female, Gastric Inhibitory Polypeptide, Glucagon, Humans, Hyperinsulinism, Hypoglycemia, Insulin, Nutritional Status, Obesity, Morbid, Postoperative Complications, Gastric Bypass, Body Mass Index, Glucagon-Like Peptide 1
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