Hypoglycemia After Gastric Bypass Successfully Treated With Calcium Channel Blockers: Two Case Reports.
Angharad AmesCarlos A Lago-HernandezEduardo GrunvaldPublished in: Journal of the Endocrine Society (2019)
Postprandial hyperinsulinemic hypoglycemia is an uncommon yet well-established complication of Roux-en-Y gastric bypass (RYGB) that can result in serious morbidity and adversely affect quality of life. It is often unrecognized and may be difficult to diagnose. Management is challenging. As the number of bariatric procedures increases in parallel with the obesity epidemic, clinicians will be tasked to offer effective medical therapies for this complication. Two patients presented several years after RYGB with severe postprandial hypoglycemia. In one of the patients, we were able to document simultaneous postprandial hypoglycemia and hyperinsulinemia. Conventional treatment approaches, including medical nutrition therapy, acarbose, diazoxide, and octreotide, were either ineffective or limited by poor tolerance. Nifedipine and verapamil were used adjunctively with dietary modification, resulting in resolution of symptomatic hypoglycemic episodes. These agents are therapeutic options that can be used for some patients refractory to more traditional treatments. They should be tried before surgical procedures are considered for affected patients. These two cases demonstrate that calcium channel blockers may be efficacious and appropriate for select patients refractory to dietary interventions alone.
Keyphrases
- end stage renal disease
- roux en y gastric bypass
- newly diagnosed
- ejection fraction
- chronic kidney disease
- type diabetes
- gastric bypass
- prognostic factors
- weight loss
- healthcare
- peritoneal dialysis
- blood pressure
- stem cells
- body mass index
- bariatric surgery
- patient reported outcomes
- single molecule
- case report
- bone marrow
- glycemic control