A Case of Type 2 Diabetes with Severe Obesity in a Patient Who Developed Postprandial Hypoglycemia after Bariatric Surgery

Abstract

We herein report the case of a 37-year-old female with a history of type 2 diabetes, dyslipidemia and hypertension who experienced repeated vomiting after undergoing laparoscopic sleeve gastrectomy with duodenal-jejunal bypass for morbid obesity (body weight: 165 kg, body mass index: 62.1 kg/m²). One year later, she developed hypoglycemic symptoms after meals. We performed an oral glucose tolerance test to determine the cause of the hypoglycemic symptoms and found that the IRI was 61.9 μU/ml and the active GLP-1 level was prominently elevated to 72.9 pmol/l at 30 minutes. We speculated that relative hyperinsulinemia and the suppression of glucagon secretion induced by the elevated GLP-1 level may have been linked to the vomiting and hypoglycemia. The present case has important implications for the surgical management of obesity in diabetic patients. With an increasing number of bariatric surgeries being performed each year, surgeons, as well as physicians, should thus be aware of the metabolic consequences that can result from these procedures.