Postprandial hypoglycemia after gastric bypass surgery from pathogenesis to diagnosis and treatmentHonka, Henria; Salehi, Marzieha,bCurrent Opinion in Clinical Nutrition & Metabolic Care: July 2019 - Volume 22 - Issue 4 - p 295–302 doi: 10.1097/MCO.0000000000000574 CARBOHYDRATES: Edited by Luc Tappy and Bettina Mittendorfer Buy Abstract Author InformationAuthors Article MetricsMetrics Purpose of review The Roux-en-Y gastric bypass surgery (RYGB) improves glucose control in majority of patients with type 2 diabetes. However, a minority group of individuals develop a life-threatening complication of hyperinsulinemic hypoglycemia. The goal of this review is to identify underlying mechanisms by which RYGB cause hypoglycemia and describe pathogenesis-driven strategies to diagnose and treat this condition. Recent findings Gastric bypass leads to higher and earlier peak levels of glucose and lower nadir glucose after eating along with larger insulin and glucagon-like peptide 1 (GLP-1) secretion, resetting the balance between glucose appearance and clearance after this procedure. These weight-loss independent glycemic effects of RYGB have been attributed to changes in ingested glucose appearance as a result of rapid nutrient emptying from stomach pouch to the intestine and increased glucose clearance as a result of prandial hyperinsulinemia. The exaggerated effect of RYGB on postmeal glucose metabolism is a syndrome of postprandial hyperinsulinemic hypoglycemia manifesting in a group of individuals several years after this surgery. Affected patients have larger systemic appearance of ingested glucose and greater postmeal secretion of insulin and GLP-1 compared to those with history of RYGB without symptomatic hypoglycemia. Current evidence supporting a multifactorial model of glucose dysregulation among patients with hypoglycemia will be highlighted in this review. Summary Hypoglycemia after RYGB is a life-threatening condition and likely represents the extreme glycemic phenotype of this procedure. Diagnosis is challenging and treatment options are limited. aDivision of Diabetes, Department of Medicine, University of Texas Health Science Center bBartter Research Unit, Audie Murphy Hospital, STVHCS, San Antonio, Texas, USA Correspondence to Marzieh Salehi, MD, MS, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA. Tel: +1 210 450 8560; e-mail: email@example.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.