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An Imbalance of Pathophysiologic Factors in Late Postprandial Hypoglycemia Post Bariatric Surgery: A Narrative Review

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Abstract

With a rise in obesity and more patients opting for bariatric surgery, it becomes crucial to understand associated complications like postprandial hypoglycemia (PPH). After bariatric surgery, significant changes are seen in insulin sensitivity, beta cell function, glucagon-like peptide 1 (GLP-1) levels, the gut microbiome, and bile acid metabolism. And in a small subset of patients, exaggerated imbalances in these functional and metabolic processes lead to insulin–glucose mismatch and hypoglycemia. The main treatment for PPH involves dietary modifications. For those that do not respond, medications or surgical interventions are considered to reverse some of the imbalances. We present a few case reports of patients that safely tolerated GLP-1 agonists. However, larger randomized control trials are needed to further characterize PPH and understand its treatment.

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Authors and Affiliations

  1. Department of Internal Medicine, Main Line Health System/Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA

    Marah Alsayed Hasan

  2. Affiliate, Main Line Health System, Emeritus, University of Pennsylvania, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA

    Stanley Schwartz

  3. Main Line Health Bariatric Surgery - Bryn Mawr, 830 Old Lancaster Road Suite 300, Bryn Mawr, PA, 19010, USA

    Victoria McKenna

  4. Bariatric Center of Bryn Mawr Hospital, Main Line Health System, Bryn Mawr Medical Building North, 830 Old Lancaster Road, Bryn Mawr, PA, 19010, USA

    Richard Ing

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  1. Marah Alsayed Hasan
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  4. Richard Ing
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Correspondence to Marah Alsayed Hasan.

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Stanley Schwartz is the advisor of Lilly Pharmaceuticals from 2022 to present. All the other authors declare no competing interests.

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Key Points

• GLP-1 agonists show benefit in postprandial hypoglycemia after bariatric surgery.

• An exaggerated imbalance in insulin and glucose regulation exists in PPH post RYGB.

• Close glucose monitoring should be recommended in patients post RYGB.

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Alsayed Hasan, M., Schwartz, S., McKenna, V. et al. An Imbalance of Pathophysiologic Factors in Late Postprandial Hypoglycemia Post Bariatric Surgery: A Narrative Review. OBES SURG 33, 2927–2937 (2023). https://doi.org/10.1007/s11695-023-06758-1

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  • DOI: https://doi.org/10.1007/s11695-023-06758-1

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