TY - JOUR

T1 - The Use of Gastrostomy Tube for the Long-Term Remission of Hyperinsulinemic Hypoglycemia After Roux-en-y Gastric Bypass

T2 - A Case Report

AU - Craig, CM

AU - Lamendola, C

AU - Holst, Jens Juul

AU - Deacon, Carolyn F.

AU - McLaughlin, TL

PY - 2015

Y1 - 2015

N2 - Objective: Hyperinsulinemic hypoglycemia is anincreasingly reported complication of Roux-en-Y gastricbypass surgery (RYGB), for which there is currently noacceptable treatment. We present a case of the reversalof severe hyperinsulinemic hypoglycemia through gastrostomytube (GT) feeding to the remnant stomach anduniquely report the durable resolution of neuroglycopenicsymptoms 3 years after GT placement.Methods: The case subject underwent standardizedpostprandial measurement of plasma glucose, insulin,glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropicpeptide (GIP), and glucagon concentrations afteroral or GT administration of a standardized liquid meal.Results: Hypersecretion of insulin, GLP-1, and glucagonelicited by oral administration of the liquid meal werereversed with GT feeding. GIP was not secreted in excessof normal after the oral meal.Conclusion: This case of reversible hyperinsulinemichypoglycemia through GT feeding illustrates the physiologyof this disorder, pointing to an exaggerated GLP-1response due to rapid nutrient transit to the distal bowel.The sustained resolution of the case subject’s neuroglycopenicsymptoms supports the use of GT as an effective anddurable treatment for severe refractory hyperinsulinemichypoglycemia after RYGB. (AACE Clinical Case Rep.2015;1:e84-e87)

AB - Objective: Hyperinsulinemic hypoglycemia is anincreasingly reported complication of Roux-en-Y gastricbypass surgery (RYGB), for which there is currently noacceptable treatment. We present a case of the reversalof severe hyperinsulinemic hypoglycemia through gastrostomytube (GT) feeding to the remnant stomach anduniquely report the durable resolution of neuroglycopenicsymptoms 3 years after GT placement.Methods: The case subject underwent standardizedpostprandial measurement of plasma glucose, insulin,glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropicpeptide (GIP), and glucagon concentrations afteroral or GT administration of a standardized liquid meal.Results: Hypersecretion of insulin, GLP-1, and glucagonelicited by oral administration of the liquid meal werereversed with GT feeding. GIP was not secreted in excessof normal after the oral meal.Conclusion: This case of reversible hyperinsulinemichypoglycemia through GT feeding illustrates the physiologyof this disorder, pointing to an exaggerated GLP-1response due to rapid nutrient transit to the distal bowel.The sustained resolution of the case subject’s neuroglycopenicsymptoms supports the use of GT as an effective anddurable treatment for severe refractory hyperinsulinemichypoglycemia after RYGB. (AACE Clinical Case Rep.2015;1:e84-e87)

U2 - 10.4158/EP14218.CR

DO - 10.4158/EP14218.CR

M3 - Journal article

VL - 1

SP - e84-e87

JO - AACE Clinical Case Reports

JF - AACE Clinical Case Reports

SN - 2376-0605

IS - 2

ER -