Hypoglycaemia one-year after laparoscopic sleeve gastrectomy: Experience of Padua Bariatric Unit

Introduction: It’s known that after Roux-en-x-en-Y gastric bypass (RYGB) about 30% of patients experienced post-prandial hyperinsulinemic hypoglycaemia following surgery. There are very few data about development of post-prandial hypoglycaemia after laparoscopic sleeve gastrectomy (LSG). Methods: We analyzed 39 non-diabetic morbidly obese patients, undergoing LSG. All patients were submitted to 3-hour OGTT for glucose (BG) and insulin plasma level measurement before surgery and one-year after LSG. The HOMA index was also calculated. Hypoglycaemia was defined as BG ≤ 3.3 mmol/L and severe hypoglycaemia as BG ≤ 2.7 moml/l. Results: After LSG 21 patients (53.8%) experienced at least one asymptomatic hypoglycaemia provoked by OGTT and 10 patients (25.6%) had at least one severe hypoglycaemia episode. Hypoglycaemic events occurred from 120’ to 180’ and the highest frequency was observed at 150’ in 16 subjects (41%). Severe hypoglycaemia occurred only from 150’ on. Homa index (HOMA-IR) significantly decreased 1-year after LSG either in patients with or without hypoglycaemia. The insulin AUC 1-year after LSG was statistically higher (p < 0,0002) in patients with hypoglycaemia. Conclusion: These findings confirm the high incidence of post-prandial hypoglycaemia 1-year after LSG emphasising also in this population the high frequency of late severe hypoglycemia. A normalization of HOMA- IR occurred in all patients thus suggesting an improvement of insulin sensitivity. The persistent insulin hyper response to an oral glucose load after surgery in most of the patients with hypoglycaemia explains, at least in part, the phenomenon.