Insulin in the Medical Management of Postprandial Hypoglycemia in a Patient with Type 2 Diabetes after Gastric Bypass Surgery. (28th June 2012)

• Record Type: Journal Article
• Authors: Schoenberger, Jennifer Leung; Koh, Chung-Kay; Hor, Tiffany; Baldwin, David; Reddy, Arati; Rondinelli-Hamilton, Lara
• Other Names: Aimaretti G. Academic Editor.; Broom I. Academic Editor.; Frindik J. P. Academic Editor.; Hattori H. Academic Editor.; Ikeda H. Academic Editor.; Irons B. K. Academic Editor.; Sakane N. Academic Editor.
• Is Part Of: Case reports in endocrinology. Volume 2012(2012)
• Publication Date: 2012-06-28
• Subjects: Endocrinology -- Periodicals; Endocrinology -- Case studies -- Periodicals; Endocrine glands -- Diseases -- Periodicals; Endocrinology; Endocrine System Diseases; Endocrine glands -- Diseases; Endocrinology; Electronic journals; Periodicals; Case studies; Periodicals; Case Reports; Fulltext; Internet Resources; Periodicals; 616.4
• DOI: 10.1155/2012/427565
• Languages: English
• ISSNs: 2090-6501

Abstract

Abstract : Objective . We evaluated a 47-year-old woman with a history of type 2 diabetes and severe obesity who developed postprandial hypoglycemia after undergoing Roux-en-Y gastric bypass surgery and losing 60% of her total body weight. We studied her insulin secretion and blood glucose dynamics and were able to tailor a therapeutic regimen involving insulin that eliminated episodes of hypoglycemia. Methods . We studied blood glucose levels during a prolonged fast, performed continuous glucose monitoring studies using a subcutaneous glucose sensor, and evaluated regional pancreatic insulin secretion using selective arterial calcium stimulation. Results . Continuous glucose monitoring revealed that the patient had early (1-2 hr) postprandial hyperglycemia followed by late (3-4 hr) postprandial hypoglycemia. Biochemical studies confirmed endogenous pancreatogenous insulin secretion as the cause of episodic hypoglycemia, but imaging studies and selective arterial calcium stimulation failed to localize an insulinoma. The patient was treated with preprandial doses of insulin aspart in order to attenuate the early postprandial hyperglycemia, and the late hypoglycemic episodes were avoided. Conclusion . We describe an interesting and novel nonsurgical approach to the prevention of postprandial hypoglycemia in a patient with noninsulinoma pancreatogenous hypoglycemia after gastric bypass.