Post-Bariatric Hypoglycaemia

Post-bariatric hypoglycaemia is a condition where blood sugar drops too low after eating, occurring in some people who have had weight loss surgery, particularly gastric bypass. It happens because food moves too quickly into the intestine, triggering an exaggerated insulin response. Symptoms include shakiness, sweating, confusion, and dizziness, usually 1-3 hours after a meal.

Post-bariatric hypoglycaemia (PBH) is characterised by symptomatic hypoglycaemia (blood glucose below 3.0 mmol/L) occurring 1-3 hours postprandially, most commonly after Roux-en-Y gastric bypass. The pathophysiology involves accelerated gastric emptying and rapid nutrient delivery to the distal ileum, triggering excessive GLP-1 secretion and subsequent hyperinsulinaemic response. Diagnosis requires documentation of Whipple’s triad: hypoglycaemic symptoms, low plasma glucose, and symptom resolution with glucose administration.

Patients who have undergone bariatric surgery should be aware of PBH as a potential late complication. Dietary modifications, including smaller, low-glycaemic-index meals and avoiding simple sugars, are first-line management. Accord Medical provides comprehensive follow-up care for all bariatric patients under Dr. Joseph Wang.