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Case Report: Post-gastrectomy reactive hyperinsulinemic hypoglicaemia: glucose trends before and after canagliflozin

G Bellastella1,2, P Caruso1, C Carbone1,2

  • 1Unit of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Naples, Italy.

Frontiers in Endocrinology
|August 30, 2023
PubMed

Insights

Canagliflozin effectively managed post-gastrectomy reactive hyperinsulinemic hypoglycemia in a patient. This sodium-glucose cotransporter-2 (SGLT-2) inhibitor reduced hypoglycemic events and improved glycemic control, as confirmed by flash glucose monitoring.

Area of Science:

  • Endocrinology
  • Gastroenterology
  • Metabolic Disorders

Background:

  • Post-gastrectomy reactive hyperinsulinemic hypoglycemia (RH) pathogenesis is unclear, with potential links to SGLT-1 transporter up-regulation.
  • Limited research exists on SGLT-1/SGLT-2 inhibitors for managing RH after gastric bypass surgery.

Observation:

  • A patient with Roux-en-Y gastric bypass (RYGB) experienced frequent postprandial hypoglycemia despite dietary modifications.
  • Flash glucose monitoring (FGM) was used to track glucose trends and assess the efficacy of canagliflozin treatment.

Findings:

  • Canagliflozin (300 mg/day) completely resolved hypoglycemic events in the patient.
  • Treatment led to reduced time in hypoglycemia, improved glycemic variability, and increased time in target glucose range.
  • Hyperglycemia also decreased, improving average glucose values and key glycemic indicators.

Implications:

  • This case report, supported by FGM data, suggests canagliflozin may be a viable treatment for post-gastrectomy RH.
  • Further research is necessary to validate these preliminary findings and confirm canagliflozin's therapeutic role.
Keywords:
FGM (flash glucose monitoring)SGLT1SGLT2canagliflozinhypoglycaemiaobesity

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