Clinical features of symptomatic hypoglycemia observed after bariatric surgery

Background: Literature directly looking at post bariatric surgery hypoglycemia consists mostly of small case series. The rate, severity, and outcomes of treatment in a large bariatric population are less characterized. Objective: To determine the rate of post bariatric surgery hypoglycemia, its clinical features and management outcomes over a 13-year period at our institution. Setting: An academic center in the United States. Methods: Patients who underwent bariatric surgery at a single academic center between 2002 and 2015 and had a postdischarge glucose level of <70 mg/dL were studied. Results: Of 6024 patients who underwent bariatric procedure, 118 patients (2.0%) had a postoperative glucose level <70 mg/dL. Eighty-three patients (1.4%) had symptomatic hypoglycemia. The known underlying causes of symptomatic hypoglycemia included postprandial hyperinsulinemic hypoglycemia (n = 32, 38%), infection (n = 8, 10%), diabetic medications (n = 8, 10%), and poor oral intake (n = 8, 10%). Overall, 9 patients required intervention for nutritional supplementation including enteral (n = 9) and intermittent parenteral (n = 2) nutrition. No patients required reversal of their bariatric surgeries or pancreatic resection for management of hypoglycemia. The majority of the symptomatic patients had resolution of their symptoms (n = 76, 92%). Thirtytwo patients had postprandial hypoglycemia with a median onset of hypoglycemia after bariatric surgery of 790 days (interquartile range 388-1334). All 32 patients with postprandial hypoglycemia had dietary adjustment and 53% received pharmacotherapy, which resulted in complete resolution of hypoglycemia (n = 29, 91%) and resolution with minimal disability (n = 3, 9%). Conclusion: The rate of symptomatic hypoglycemia and postprandial hypoglycemia after bariatric surgery were 1.4% and.5%. The majority of patients were successfully managed with dietary counseling, nutritional intervention, and occasionally pharmacotherapy. No surgical reversal or pancreatic procedures were performed. (Surg Obes Relat Dis 2018;14:1335-1339.) (C) 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.