Endocrine Abstracts

Introduction: In a fraction of morbidly obese subjects undergoing gastric bypass (GBP), episodes with late postprandial hypoglycemia (PPHG) develop 1–3 years after surgery. The pathogenesis of this phenomenon is not fully understood; meal-induced rapid and exaggerated increases of circulating incretins and insulin appear to be partially responsible. Current treatments include low-carbohydrate diets, inhibition of glucose intestinal uptake, reduction of insulin secretion with calcium channel blockers, somatostatin analogs, or diazoxide, a KATP channel opener. Even partial pancreatectomy has been advocated.

In type 2 diabetes, GLP1 analogs have a well-documented effect of stabilizing glucose levels without causing hypoglycemia. Here, we explored GLP1 analogs (exenatide/liraglutide) as open treatment in eight consecutive GBP cases seeking medical attention because of late postprandial hypoglycemic symptoms.

Case reports: Patients were admitted because of hypoglycemia 1–4 years post-GBP surgery. They were thoroughly and negatively investigated for other causes of hypoglycemia than post-GBP hypoglycemia. No glucose modifying drugs were used, and none had diabetes (one patient had remitted preoperative diabetes). Glucose values, measured in connection with a hypoglycemic episode in six of the cases, were 2.7, 2.5, 1.8, 3.5, 2.3, and 1.6? mmol/l respectively.

All eight patients consistently described that the analogs eliminated their symptoms. Furthermore, the symptoms relapsed when, in four of the patients, treatment was reduced/discontinued. In one case, the drug effect was also documented by repeated 24 h continuous glucose measurements.

Conclusion: These open observations suggest that GLP1 analogs might provide a new effective treatment option in patients with problems of late PPHG. The analogs have a more benign side-effect profile than other drugs used against postprandial hypoglycemia, We speculate that their beneficial effect might be by strengthening the counter-regulatory response to hypoglycemia.