The Use of Gastrostomy Tube for the Long-Term Remission of Hyperinsulinemic Hypoglycemia After Roux-en-y Gastric Bypass: A Case Report

Objective: Hyperinsulinemic hypoglycemia is an
increasingly reported complication of Roux-en-Y gastric
bypass surgery (RYGB), for which there is currently no
acceptable treatment. We present a case of the reversal
of severe hyperinsulinemic hypoglycemia through gastrostomy
tube (GT) feeding to the remnant stomach and
uniquely report the durable resolution of neuroglycopenic
symptoms 3 years after GT placement.
Methods: The case subject underwent standardized
postprandial measurement of plasma glucose, insulin,
glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic
peptide (GIP), and glucagon concentrations after
oral or GT administration of a standardized liquid meal.
Results: Hypersecretion of insulin, GLP-1, and glucagon
elicited by oral administration of the liquid meal were
reversed with GT feeding. GIP was not secreted in excess
of normal after the oral meal.
Conclusion: This case of reversible hyperinsulinemic
hypoglycemia through GT feeding illustrates the physiology
of this disorder, pointing to an exaggerated GLP-1
response due to rapid nutrient transit to the distal bowel.
The sustained resolution of the case subject’s neuroglycopenic
symptoms supports the use of GT as an effective and
durable treatment for severe refractory hyperinsulinemic
hypoglycemia after RYGB. (AACE Clinical Case Rep.
2015;1:e84-e87)