Aktuelle Ernährungsmedizin 2017; 42(03): 241-272
DOI: 10.1055/s-0037-1603236
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Georg Thieme Verlag KG Stuttgart · New York

IS TESTING FOR POSTPRANDIAL HYPERINSULINEMIC HYPOGLYCEMIA AFTER GASTRIC BYPASS NECESSARY?

E Aubry
1   Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, University Hospital and University of Bern
,
M Gasser
2   European Center of Excellence for Bariatric and Metabolic Surgery, Bern, Switzerland
,
C Meier-Estermann
2   European Center of Excellence for Bariatric and Metabolic Surgery, Bern, Switzerland
,
S Herren
2   European Center of Excellence for Bariatric and Metabolic Surgery, Bern, Switzerland
,
R Steffen
2   European Center of Excellence for Bariatric and Metabolic Surgery, Bern, Switzerland
,
Z Stanga
1   Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, University Hospital and University of Bern
› Institutsangaben
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Publikationsdatum:
20. Juni 2017 (online)

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    Introduction:

    Bariatric surgery is the most efficient and only durable treatment of severe obesity [1][2]. Standard Roux-en-Y gastric bypass (RYGB) takes an intermediate position in the risk benefit ratio and is the operation of choice for thousands of patients. Most long-term sequels are well known and require a lifelong follow-up [1]. One increasingly reported complication is the postprandial hyperinsulimic hypoglycemia (pHH). As it can cause life threatening emergencies without warning symptoms, provocative testing can detect patients at risk.

    Objectives:

    The objective of this study was to determine the prevalence of pHH after RYGB with or without symptoms of hypoglycemia.

    Methods:

    Observational cohort study of consecutive, unselected patients 11 to 28 months after uncomplicated laparoscopic standard RYGP. In order to simulate normal habits patients received a carbohydrate rich standardized solid mixed meal. Insulin and glucose were measured at 30, 60, 90, 120 and 150 minutes thereafter. Symptoms were recorded and classified as autonomous or neuroglycopenic. Patients with hypoglycemia, defined as blood glucose of < 3.3 mmol/L, were tested a second time within a week with a protein rich standardized solid mixed meal.

    Results:

    A total of 113 consecutive, non-selected patients were included. Total postoperative weight loss was 33.97 ± 9.3%. In 24.8% of patients glucose dropped to less than 3.3 mmol/L, 13.8% to less than 3.0 mmol/L after carbohydrate solid mixed meal in contrast to only one patient after protein rich meal (0% with less than 3.0 mmol/L). Only 40.7% showed hypoglycemic symptoms. One patient needed emergency treatment after sudden loss of consciousness 80 minutes after carbohydrate meal. Asymptomatic patients carry a significant risk (p < 0.01) for pHH.

    Conclusion:

    pHH after RYGB can be life threatening and occur without warning symptoms. Therefore, testing all patients is necessary. How, when and how often remains to be investigated. A standardized solid food test is an option close to daily life situations and patients can be counselled according to the obtained results.

    References:

    [1] Roslin MS, Dudiy Y, Brownlee A, Weiskopf J, Shah P. Response to glucose tolerance testing and solid high carbohydrate challenge: comparsion between Roux- en-Y gastric bypass, vertical sleeve gastrectomy an duodenal switch. Surg Endosc 2014;28(1);91 – 9.

    [2] Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) tial- a prospektive controlled intervention study of bariatric surgery. J Intern Med 2013;273(3):219 – 34.

    Disclosure of Interest:

    None declared.


     

    Die Autoren geben an, dass kein Interessenkonflikt besteht.