Post-Bariatric Surgery Hypoglycemia

Highlights

Meal-induced hypoglycemia is a well-known complication associated with bariatric surgery. This study examined the relationship between self-reported symptoms and postprandial glycemic profiles in patients with post-bariatric surgery hypoglycemia.
The authors analyzed blinded records and self-reported symptoms during a 50-day free-living period among 30 patients, with a total of 5851 postprandial periods. Of the hypoglycemic symptoms reported, 45% occurred in the hypoglycemic phase, with the majority of symptoms corresponding to the autonomic type.
Nearly half of the reported hypoglycemia symptoms were not noticed during hypoglycemia, suggesting the complexity of the association between hypoglycemia symptoms and glucose levels in this patient population.

Aim

Post-bariatric surgery hypoglycemia ( PBH) is a metabolic complication of Roux-en-Y gastric bypass (RYGB). Since symptoms are a key component of Whipple’s triad in diagnosing nondiabetic hypoglycemia, we evaluated the relationship between self-reported symptoms and postprandial sensor glucose profiles.

Methodology

Thirty patients with post-bariatric surgery hypoglycemia (PBH) after Roux-en-Y gastric bypass (RYGB) (age: 50.1 [41.6–60.6] years, 86.7% female, BMI: 26.5 [23 .5–31.2] kg/m 2 ; median [interquartile range]) used a blinded Dexcom G6 sensor while recording autonomic, neuroglycopenic, and gastrointestinal symptoms for 50 days.

Symptoms (overall and each type) were classified as those occurring in postprandial periods (PPP) without hypoglycemia , or in the dynamic or preceding hypoglycemic phase of PPP with hypoglycemia (nadir sensor glucose <3.9 mmol/L).

We further explored the relationship between symptoms and maximum negative rate of change of sensor glucose and nadir sensor glucose levels.

Results

In 5851 postprandial periods (PPP), 775 symptoms were reported, of which 30.6% (0.0-59.9) were perceived in PPP without hypoglycemia , 16.7% (0.0-30.1) in the preceding dynamic phase and 45.0% (13.7-84.7) in the hypoglycemic phase of PPP with hypoglycemia .

By type of symptom, 53.6 (23.8–100.0) % of autonomic, 30.0 (5.6–80.0) % of neuroglycopenic and 10.4 (0.0– 50.0) % of gastrointestinal symptoms occurred in the hypoglycemic phase of PPP with hypoglycemia.

Both faster glucose dynamics and lower nadir sensor glucose levels were related to symptom perception.

Conclusions

The relationship between symptom perception and PBH is complex and challenges clinical judgment and decision making in this population.

Post-Bariatric Surgery Hypoglycemia

This study investigates the relationship between symptom perception and postprandial glycemic profiles in patients experiencing hypoglycemia after Roux-en-Y gastric bypass surgery, shedding light on the management of this challenging complication.