Use of diazoxide in management of severe postprandial hypoglycemia in patient after Roux-en-Y gastric bypass

González-González, Abel; Delgado, Manuel; Fraga-Fuentes, Maria D.

doi:10.1016/j.soard.2011.05.010

Cited by 38 publications

(28 citation statements)

References 11 publications

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“…The mechanism of action is through the ATP‐sensitive potassium channel, and it inhibits insulin release from beta‐cells. The use of diazoxide for the treatment of postbariatric surgery hypoglycaemia has been described . The side effects are hypotension, fluid retention and hirsutism.…”

Section: Treatment Optionsmentioning

confidence: 99%

Post‐gastric bypass hypoglycaemia: a review

Shantavasinkul

Torquati

Corsino

2016

Clinical Endocrinology

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SummaryBariatric surgery is a highly effective treatment for severe obesity, resulting in substantial weight loss and normalizing obesityrelated comorbidities. However, long-term consequences can occur, such as postbariatric surgery hypoglycaemia. This is a challenging medical problem, and the number of patients presenting with it has been increasing. Roux-en-Y gastric bypass (RYGB) is the most popular bariatric procedure, and it is the surgery most commonly associated with the development of postbariatric surgery hypoglycaemia. To date, the pathogenesis of this condition has not been completely established. However, various factorsparticularly increased postprandial glucagon-like peptide (GLP)-1 secretion -have been considered as crucial mediator. The mechanisms responsible for diabetic remission after bariatric surgery may be responsible for the development of hypoglycaemia, which typically occurs 1-3 h after a meal and is concurrent with inappropriate hyperinsulinaemia. Carbohydrate-rich foods usually provoke hypoglycaemic symptoms, which can typically be alleviated by strict dietary modifications, including carbohydrate restriction and avoidance of high glycaemic index foods and simple sugars. Few patients require further medical intervention, such as medications, but some patients have required a pancreatectomy. Because this option is not always successful, it is no longer routinely recommended. Clinical trials are needed to further determine the pathophysiology of this condition as well as the best diagnostic and treatment approaches for these patients.

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Section: Treatment Optionsmentioning

confidence: 99%

Post‐gastric bypass hypoglycaemia: a review

Shantavasinkul

Torquati

Corsino

2016

Clinical Endocrinology

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“…Several treatments have been proposed in the literature; these involve acarbose (24,25), calcium channel antagonists (nifedipine and verapamil) (26), the somatostatin analogues octreotide (27) and pasireotide (28), the b-cell inhibitor diazoxide (29), and finally and ultimately, partial pancreatectomy (30). Glucagon has been tried as infusion but has not been proven to be useful perhaps because of its concomitantly high levels of insulin (31).…”

Section: Introductionmentioning

confidence: 99%

Hypoglycemia in everyday life after gastric bypass and duodenal switch

Abrahamsson

Engström

Sundbom

et al. 2015

European Journal of Endocrinology

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Design: Gastric bypass (GBP) and duodenal switch (DS) in morbid obesity are accompanied by marked metabolic improvements, particularly in glucose control. In recent years, episodes of severe late postprandial hypoglycemia have been increasingly described in GBP patients; data in DS patients are scarce. We recruited three groups of subjects; 15 GBP, 15 DS, and 15 non-operated overweight controls to examine to what extent hypoglycemia occurs in daily life. Methods: Continuous glucose monitoring (CGM) was used during 3 days of normal activity. The glycemic variability was measured by mean amplitude of glycemic excursion and continuous overall net glycemic action. Fasting blood samples were drawn, and the patients kept a food and symptom log throughout the study. Results: The GBP group displayed highly variable CGM curves, and 2.9% of their time was spent in hypoglycemia (!3.3 mmol/l, or 60 mg/dl). The DS group had twice as much time in hypoglycemia (5.9%) and displayed CGM curves with little variation as well as lower HbA1c levels (29.3 vs 35.9 mmol/mol, P!0.05). Out of a total of 72 hypoglycemic episodes registered over the 3-day period, 70 (97%) occurred in the postprandial state and only about one-fifth of the hypoglycemic episodes in the GBP and DS groups were accompanied by symptoms. No hypoglycemias were seen in controls during the 3-day period. Conclusion: Both types of bariatric surgery induce marked, but different, changes in glucose balance accompanied by frequent, but mainly unnoticed, hypoglycemic episodes. The impact and mechanism of hypoglycemic unawareness after weight-reduction surgery deserves to be clarified.

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“…Acarbose has been shown to improve metabolic profiles, as mentioned above [34,35]. Diazoxide, a benzothiadiazine derivative, reduced insulin secretion in one patient [38], but in our experience it leads to many adverse side effects. Insulin analogue injection was tested in 10 patients [23], and did not modify the glycaemic profile other than by lowering the glycaemic nadir further (1.9 ± 0.6 vs 2.5 ± 0.8 mmol/l).…”

Section: Treatmentsmentioning

confidence: 56%

Hypoglycaemia after gastric bypass: mechanisms and treatment

Ritz

Barigou

Hanaire

2016

Diabetes Obesity Metabolism

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Hypoglycaemia after gastric bypass can be severe, but is uncommon, and is sometimes only revealed through monitoring glucose concentrations. The published literature is limited by the heterogeneity of the criteria used for diagnosis, arguing in favour of the Whipple triad with a glycaemia threshold of 55 mg/dl as the diagnostic reference. Women who lost most of their excess weight after gastric bypass, long after the surgery was performed, and who did not have diabetes before surgery are at the greatest risk. In this context, hypoglycaemia results from hyperinsulinism, which is either generated by pancreas anomalies (nesidioblastosis) and/or caused by an overstimulation of β cells by incretins, mainly glucagon-like peptide-1 (GLP-1). Glucose absorption is both accelerated and increased because of the direct communication between the gastric pouch and the jejunum. This is a post-surgical exaggeration of a natural adaptation that is seen in patients who have not undergone surgery in whom glucose is infused directly into the jejunum. There is not always a correspondence between symptoms and biological traits; however, hyperinsulinism is constant if hypoglycaemia is severe and there are neuroglucopenic symptoms. The treatment relies firstly on changes in eating habits, splitting food intake into five to six daily meals, slowing gastric emptying, reducing the glycaemic load and glycaemic index of foods, using fructose and avoiding stress at meals. Pharmacological treatment with acarbose is efficient, but other drugs still need to be validated in a greater number of subjects (insulin, glucagon, calcium channel blockers, somatostatin analogues and GLP-1 analogues). Lastly, if the surgical option has to be used, the benefits (efficient symptom relief) and the risks (weight regain, diabetes) should be weighed carefully.

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Use of diazoxide in management of severe postprandial hypoglycemia in patient after Roux-en-Y gastric bypass

Cited by 38 publications

References 11 publications

Post‐gastric bypass hypoglycaemia: a review

Post‐gastric bypass hypoglycaemia: a review

Hypoglycemia in everyday life after gastric bypass and duodenal switch

Hypoglycaemia after gastric bypass: mechanisms and treatment

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