Diagnosis and Management of Post-Bariatric Hypoglycemia

With 1 in 8 people worldwide living with obesity, bariatric procedures continue to increase in popularity with more than a half million surgeries performed yearly. Postbariatric hypoglycemia (PBH) is now recognized as a complication of bariatric and upper gastrointestinal surgeries. While prevalence remains uncertain, symptoms have been reported in up to 30% of postsurgical patients. PBH is characterized by postprandial hypoglycemia causing neuroglycopenic symptoms of confusion, loss of consciousness, and seizures in a smaller subset of patients. Patient symptoms are often falsely attributed to other more common medical conditions due to the nonspecific nature of symptoms and lack of recognition of this complication, contributing to a frequent delay in diagnosis for many years. Our narrative review provides a summary of how to diagnose PBH, distinction of PBH from dumping syndrome, and detailed evidence-based guidance on selecting treatment. We also present the most up-to-date research involving the pathophysiology of PBH. Our goal is to raise awareness of how to diagnose and treat PBH as prompt diagnosis can lead to early treatment intervention to reduce hypoglycemic episodes and potentially decrease the development of hypoglycemia unawareness.