Recognition and management of hyperinsulinemic hypoglycemia after bariatric surgery

Sarah Malik, James E. Mitchell, Kristine Steffen, Scott Engel, Ron Wiisanen, Luis Garcia, Shahbaz Ali Malik

Research output: Contribution to journalReview articlepeer-review

44 Scopus citations


Hyperinsulinemic hypoglycemia with neuroglycopenia is an increasingly recognized complication of Roux-en-Y gastric bypass (RYGB) due to the changes in gut hormonal milieu. Physicians should be aware of this complication to ensure timely and effective treatment of post-RYGB patients, who present to them with hypoglycemic symptoms. Possible causes of hypoglycemia in these patients include late dumping syndrome, nesidioblastosis and rarely insulinoma. Systematic evaluation including history, biochemical analysis, and diagnostic testing might help in distinguishing among these diagnoses. Continuous glucose monitoring is also a valuable tool, revealing the episodes in the natural environment and can also be used to monitor treatment success. Treatment should begin with strict low carbohydrate diet, followed by medication therapy. Therapy with diazoxide, acarbose, calcium channel blockers and octreotide have been proven to be beneficial, but the response apparently is highly variable. When other treatment options fail, surgical options can be considered.

Original languageEnglish (US)
Pages (from-to)1-14
Number of pages14
JournalObesity Research and Clinical Practice
Issue number1
StatePublished - Jan 1 2016
Externally publishedYes


  • Bariatric surgery
  • Dumping syndrome
  • Glucagon like peptide-1 (GLP-1)
  • Hypoglycemia
  • Nesidioblastosis

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics


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