Abstract
Post-bariatric hypoglycemia (PBH) is an increasingly recognized long-term complication of bariatric surgery. The nutritional treatment of PBH includes a high-fiber diet and the restriction of soluble and high-glycemic index carbohydrates; however, these measures are not always enough to prevent hypoglycemia. We evaluated the efficacy of uncooked cornstarch, a low-glycemic index carbohydrate characterized by slow intestinal degradation and absorption, in addition to a high-fiber diet, for the treatment of PBH. We report the cases of two young women suffering from severe postprandial and fasting hypoglycemia following Roux-en-Y gastric bypass (RYGB). The patients underwent Continuous Glucose Monitoring (CGM) before and 12–16 weeks after the administration of uncooked cornstarch (respectively 1.25 g/kg b.w. and 1.8 g/kg b.w.) in addition to a high-fiber diet. In both patients, CGM showed more stable glucose levels throughout monitoring, a remarkable reduction of the time spent in hypoglycemia (<55 mg/dL) both during the day (−11% for both patients) and the night (−22% and −32%), and the improvement of all glycemic variability indexes. Our report, within the limit of only two cases, suggests that the implementation of a dietary intervention through the addition of uncooked cornstarch reduces daily glycemic fluctuations and hypoglycemic episodes in patients with PBH.
Highlights
Post-bariatric hypoglycemia (PBH) is an increasingly recognized complication of bariatric surgery characterized by low blood glucose levels typically occurring 1–3 h after a meal with the associated autonomic and neuroglycopenic symptoms, which are resolved after glucose ingestion [1].The real prevalence of PBH is unknown and varies from 1 to ~30% according to definition and methods of diagnosis; i.e., hospitalization data or detection of characteristic symptoms through specific questionnaires [2,3,4,5]
Using continuous glucose monitoring (CGM) over five days, Kefurt et al showed that 75% of patients undergoing Roux-en-Y gastric bypass (RYGB)
Uncooked cornstarch is a low-glycemic index carbohydrate characterized by a slow intestinal degradation and absorption
Summary
Post-bariatric hypoglycemia (PBH) is an increasingly recognized complication of bariatric surgery characterized by low blood glucose levels typically occurring 1–3 h after a meal with the associated autonomic and neuroglycopenic symptoms, which are resolved after glucose ingestion [1]. The treatment of PBH is based on the increased consumption of dietary fiber to slow carbohydrate (CHO) absorption and restrict soluble and high-glycemic index carbohydrates These dietary measures often yield only modest benefits in patients with severe symptoms, requiring the addition of acarbose or, drugs inhibiting insulin secretion [11,12]. Uncooked cornstarch is a low-glycemic index carbohydrate characterized by a slow intestinal degradation and absorption For these characteristics, it has been used in the management of conditions associated with a high-risk of hypoglycemia, including glycogen storage diseases, type 1 diabetes, and insulin autoimmune syndrome (Hirata’s disease) [13,14,15]. We present two patients suffering from severe hypoglycemia following RYGB in whom the administration of cornstarch, associated with a rich-fiber low-carbohydrate index diet, stabilized glucose profile and reduced hypoglycemic episodes
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