Successful management with GLP-1 agonists in postprandial hyperinsulinemic hypoglycemia after roux-en-y gastric bypass: clinical case descriptionand review of the literature

Abstract

Introduction: Obesity is a global pandemic, in Colombia 49% of the adult population is morbidly overweight or obese. Bariatric surgery has proved to be the most effective long-term treatment for the management of morbid obesity and resolution of comorbidities metabolic and mechanical. Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is related to postprandial hyperinsulinemic hypoglycemia (PPH). This condition can occur up to 70% of patients with gastric resections and generate much morbidity to the patient. Main : To describe the use of GLP-1 analogs in the management of patients with PPH secondary to bariatric surgery Methods : To describe a case of a patient with severe dumping referred for surgical reversion due to refractoriness to the extrainstitutional medical management. Results: patient with severe hypoglycemia post LRYGB with 17 Sigstad score, 2 years of evolution with impairment of quality of life, is referred for interdisciplinary management in the obesity clinic of our institution. We starts with Anatomical and physiological studies of their surgery, nutritional assessment, and endocrinology initiates liraglutide with improvement of 80% of the symptoms. Conclusion : In LRYGB patients with hypoglycemia, HHP, nesidioblastosis and insulinoma should be ruled out as a diagnosis. The presence of wide anastomoses that allow fast gastric emptying, high carbohydrate foods favor the symptoms. The use of GLP-1 analogs together with dietary measures have shown that they improve symptoms and quality of life in the long term, apparently these results are due to the stabilization of insulin peaks and delayed gastric emptying.