Bariatric surgery is increasingly recognized as a potent tool for the treatment of type 2 diabetes (T2D), yielding not only weight loss but also rapid improvements in glycemia allowing discontinuation of diabetes-related medication within days after surgery. However, along with this metabolic success comes an increased incidence of severe hypoglycemia (termed post-bariatric hypoglycemia; PBH) for a subset of individuals.~The goal of these studies is to identify physiological and molecular mechanisms that underlie PBH, to determine whether these changes also contribute to surgery-induced improvements in glucose regulation (homeostasis), and to define potential new therapeutic interventions for PBH.~Participation in this study will take place over four visits, which will include the following:~Detailed history, physical exam, and laboratory testing to determine study eligibility~Assessment of glucose patterns using a masked continuous glucose monitor;~Analysis of a stool sample (collected at home);~Measuring glucose and hormone levels in response to a meal;~Measuring glucose and hormone levels in response to an injection of glucagon;~Measuring hormone levels while glucose levels are gradually lowered, and during a controlled period of a low glucose level (hypoglycemic clamp).~Investigators will test the hypothesis that counterregulatory hormone responses are impaired in individuals with PBH, and that differences in the intestinal bacteria (microbiome) and hormones produced in response to a meal may contribute to this condition.
Post-bariatric hypoglycemia (PBH) is an increasingly recognized syndrome that is incompletely understood.~The purpose of this study is to increase our level of understanding by investigating mechanisms contributing to this condition.~Participation in this study will take place over four visits, which will include the following:~Wearing of a continuous glucose monitoring device;~Providing a stool sample (collected at home);~Measuring glucose and hormone levels in response to a meal;~Measuring glucose and hormone levels in response to an injection of glucagon;~Measuring hormone levels while glucose levels are gradually lowered, and during a controlled period of a low glucose level (hypoglycemic clamp).~Investigators will test the hypothesis that counterregulatory hormone responses are impaired in individuals with PBH, and that differences in the intestinal bacteria (microbiome) may contribute to this condition.