Post-Gastric Bypass Hyperinsulinemic Hypoglycemia: Fructose is a Carbohydrate Which Can Be Safely Consumed

• Published in: The journal of clinical endocrinology and metabolism Vol. 100; no. 8; pp. 3097 - 3102
• Main Authors: Bantle, Anne E, Wang, Qi, Bantle, John P
• Format: Journal Article
• Language: English
• Published: United States Endocrine Society 01.08.2015; Copyright by The Endocrine Society
• Subjects: Adult; Blood Glucose - drug effects; Blood Glucose - metabolism; Cross-Over Studies; Female; Fructose - therapeutic use; Gastric Bypass - adverse effects; Gastroesophageal Reflux - blood; Gastroesophageal Reflux - surgery; Humans; Hyperinsulinism - etiology; Hyperinsulinism - prevention & control; Hypoglycemia - etiology; Hypoglycemia - prevention & control; Insulin - blood; Insulin Lispro - therapeutic use; Male; Meals; Middle Aged; Obesity - blood; Obesity - surgery; Original; Postoperative Complications - prevention & control
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2015-1283

Context: Postprandial hypoglycemia after gastric bypass surgery is a serious problem. Available treatments are often ineffective. Objective: The objective was to test the hypotheses that injection of rapid-acting insulin before a high-carbohydrate meal or replacement of other carbohydrates with fructose in the meal would prevent hypoglycemia. Design: This was a randomized, crossover trial comparing a high-carbohydrate meal with premeal saline injection (control), a high-carbohydrate meal with premeal insulin injection, and a high-fructose meal with total carbohydrate content similar to the control meal. Setting: The setting was an academic medical center. Patients: Ten patients with post-gastric bypass hyperinsulinemic hypoglycemia participated. Interventions: Interventions included lispro insulin injected before test meals and replacement of other carbohydrates with fructose in test meals. Main Outcome Measure: The main outcome measure was plasma glucose < 60 mg/dL after test meals. Results: After the control meal, mean peak glucose and insulin were 173 ± 47 mg/dL and 134 ± 55 mU/L, respectively; mean glucose nadir was 44 ± 15 mg/dL; and eight of 10 subjects demonstrated glucose < 60 mg/dL. Five subjects demonstrated a glucose nadir < 40 mg/dL. There were no significant differences in the corresponding values after premeal insulin treatment, except that the mean glucose nadir of 34 ± 10 mg/dL was lower (P < .05). After the fructose meal, mean peak postprandial glucose and insulin were 117 ± 20 mg/dL and 45 ± 31 mU/L, respectively (both P < .001 for comparison with control), mean glucose nadir was 67 ± 10 mg/dL (P < .001), and two of 10 subjects demonstrated glucose < 60 mg/dL (P < .05). Conclusions: People with post-gastric bypass hypoglycemia can consume a meal sweetened with fructose with little risk of hypoglycemia. Treatment with rapid-acting insulin before a carbohydrate-containing meal did not prevent hypoglycemia.