Obesity and its complications are common, yet on the rise. Subsequently, gastric bypass surgery is on the rise too. Severe hypoglycemia can be a long-term complication of bariatric surgery. The most common method to negate or reduce hypoglycemia is dietary modifications. Patients need to consume small meals of a low glycemic index frequently. Medical therapies with acarbose, diazoxide, and octreotide are often not useful.
Here authors describe the utility of calcium channel blockers (CCBs) in two patients. Difficult to treat hypoglycemia developed in 8 and 13 years after the bypass procedure. Standard approach did not work. Only the use of nifedipine and verapamil improved patient's resistant hypoglycemia. The proposed rationale is that CCBs reduce or delay insulin secretion by pancreatic beta cells.
Although more clinical studies are needed, it is essential to be aware of the potential benefits of CCBs. For some patients with refractory and devastating hypoglycemia, they could be the last resort. Additionally, physicians are already familiar with CCBs as they have been on the market for decades.