POSTPRANDIAL HYPERINSULINEMIC HYPOGLYCEMIA AFTER BARIATRIC SURGERY

Associated with the obesity epidemic and the growing number of bariatric surgery procedures being performed worldwide, the incidence of reported complications has increased as well. Among these, the postprandial hyperinsulinemic hypoglycemia (PHH) warrants further attention. This condition is not entirelly understood and is probably underdiagnosed. The PHH is characterized by hypoglycemic symptoms occurring after a meal accompanied by a low plasma glucose value, typically preceded by a high rise in both glucose and insulin concentrations. Patients with PHH have shown increased glucose variability with a rapid increase in glucose absorption into the systemic circulation and an increase in glucose disappearance, with glucose values reaching both the hyperglycemic and hypoglycemic areas. It should be suspected in patients with postprandial adrenergic or neuroglycopenic symptoms after bariatric surgery1. It was considered most commonly associated with Roux-en Y gastric bypass (RYGB), although it was also described after biliopancreatic diversion (BPD), BPD with duodenal switch2, sleeve gastrectomy, and other surgical procedures which compromises the pylorus and the gastric emptying3. It has not been observed after adjustable gastric banding, an intervention that does not alter the gastrointestinal anatomy4-5.