Prolonged Successful Therapy for Hyperinsulinaemic Hypoglycaemia after Gastric Bypass: The Pathophysiological Role of GLP1 and Its Response to a Somatostatin Analogue
Abstract
Background Spontaneous hyperinsulinaemic hypoglycaemia following gastric bypass surgery (GBS) is increasingly recognised. However, its pathophysiology remains unclear. Some patients require pancreatectomy. Medical therapy with calcium channel blockers, acarbose and diazoxide has been reported to be beneficial but has variable adherence and response. Method We demonstrate the role of GLP1, counter-regulatory hormones and the subsequent response of GLP1 to somatostatin analogue therapy in a 42-year-old woman with persistent neuroglycopaenia 6 years after GBS. Plasma GLP1, insulin and glucose were measured for 5 h on three settings: i) a 75 g oral glucose tolerance test (OGTT); ii) a standard liquid test meal (LTM); and iii) an OGTT 30 min after a s.c. injection of 100 μg octreotide. Results In comparison with obese non-diabetic controls, the patient had an elevated fasting and a markedly enhanced GLP1 response during the OGTT, followed by an exaggerated insulin response and a subsequent low glucose level. The GLP1 response to a LTM was similar but greater. Octreotide given prior to the OGTT attenuated both the GLP1 and insulin responses and abolished hypoglycaemia. Octreotide therapy significantly improved the patient's neuroglycopaenic symptoms. The hormone profile was reassessed after 6 months following the LTM preceded by octreotide injection. Peak GLP1 and insulin responses were less pronounced than pretreatment responses and without hypoglycaemia. The patient was treated w…
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Diazoxide and SSTR analogs have been used with varying success in PBH.
“Diazoxide and SSTR analogs have also been used with varying success [59-61].”
From Non-Diabetic Hypoglycemia: Evaluation and Management in Adults (2025) · cites this paper as [60]
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Self-citationNon-Diabetic Hypoglycemia: Evaluation and Management in Adults
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- Authors
- Myint, K. S., Greenfield, J. R., Farooqi, I. S., Henning, E., Holst, J. J., & Finer, N.
- Affiliations
- University of Cambridge (GB)
- University of Copenhagen (DK)
- Corresponding author
- Myint, K. S.
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-03-09
- Volume
- 166
- Issue
- 5
- Pages
- 951-955
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2114161811
- Cited by
- 77
- References
- 9
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 6 · 2020: 7 · 2019: 6 · 2018: 5 · 2017: 3 · 2016: 9 · 2015: 7 · 2014: 9 · 2013: 4 · 2012: 2
- FWCI
- 7.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- Wellcome Trust
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- hyperinsulinemic hypoglycemia, gastric bypass, glucagon-like peptide-1, somatostatin analogues, octreotide, lanreotide, incretin response, counterregulatory hormones, insulin response, medical therapy
- MeSH terms
- Adult, Female, Humans, Somatostatin, Time Factors, Octreotide, Gastric Bypass, Congenital Hyperinsulinism, Nesidioblastosis, Glucagon-Like Peptide 1
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