The Use of Gastrostomy Tube for the Long-Term Remission of Hyperinsulinemic Hypoglycemia After Roux-En-y Gastric Bypass: A Case Report
Open accessAbstract
Objective: Hyperinsulinemic hypoglycemia is an increasingly reported complication of Roux-en-Y gastric bypass surgery (RYGB), for which there is currently no acceptable treatment. We present a case of the reversal of severe hyperinsulinemic hypoglycemia through gastrostomy tube (GT) feeding to the remnant stomach and uniquely report the durable resolution of neuroglycopenic symptoms 3 years after GT placement. Methods: The case subject underwent standardized postprandial measurement of plasma glucose, insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), and glucagon concentrations after oral or GT administration of a standardized liquid meal. Results: Hypersecretion of insulin, GLP-1, and glucagon elicited by oral administration of the liquid meal were reversed with GT feeding. GIP was not secreted in excess of normal after the oral meal. Conclusion: This case of reversible hyperinsulinemic hypoglycemia through GT feeding illustrates the physiology of this disorder, pointing to an exaggerated GLP-1 response due to rapid nutrient transit to the distal bowel. The sustained resolution of the case subject's neuroglycopenic symptoms supports the use of GT as an effective and durable treatment for severe refractory hyperinsulinemic hypoglycemia after RYGB. Abbreviations: GIP glucose-dependent insulinotropic peptide GLP-1 glucagon-like peptide-1 GT gastrostomy tube RYGB Roux-en-Y gastric bypass
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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 [69]
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- [1]1. McLaughlin, T.L. ∙ Peck, M. ∙ Holst, J.J. ... Reversible hyperinsulinemic hypoglycemia after gastric bypass: a consequence of altered nutrient delivery J Clin Endocrinol Metab. 2010; 95:1851-1855 Crossref Scopus (148) PubMed Google Scholar
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Sheehan, A., & Patti, M. E. (2020) · Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy · doi:10.2147/dmso.s233078 · Cited by 39 · see citing works
Non-Diabetic Hypoglycemia: Evaluation and Management in Adults
Looi, E., & Lawler, H. M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14134393 · Cited by 10 · see citing works
“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].”
- Authors
- Craig, C. M., Lamendola, C., Holst, J. J., Deacon, C. F., & McLaughlin, T. L.
- Affiliations
- Stanford Medicine (US)
- University of Copenhagen (DK)
- Corresponding author
- Craig, Colleen M.
- Venue
- AACE Clinical Case Reports
- Publisher
- Elsevier BV
- Published
- 2015
- Volume
- 1
- Issue
- 2
- Pages
- e84-e87
- ISSN
- 2376-0605 (ISSN-L)
- OpenAlex
- W2179286416
- Cited by
- 15
- References
- 0
- Citations by year
- 2025: 1 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 4 · 2018: 1 · 2017: 3 · 2016: 1
- FWCI
- 1.68
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- AACE Clinical Case Reports (publishedVersion, cc-by-nc-nd)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- hyperinsulinemic hypoglycemia, Roux-en-Y gastric bypass, gastrostomy tube feeding, remnant stomach, glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide, glucagon, insulin hypersecretion, neuroglycopenic symptoms, bariatric surgery complications
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