Role of GLP-1 in Hyperinsulinemic Hypoglycemia Post-bariatric Surgery

The physiologic mechanisms mediating the glucose-lowering effect of Roux-en-Y Gastric Bypass
(RYGB) or post-Vertical Sleeve Gastrectomy (VSG) are unknown. The reduction in glucose
excursions prior to weight loss has lead to postulates that the incretin hormone, GLP-1, may
play an important role.

The purpose of this study is to evaluate the role of GLP-1 in causing extreme postprandial
glucose reductions in a subset of post-bariatric patients through the pharmacologic blockade
of the GLP-1 receptor in post-RYGB or post-VSG patients with severe symptomatic
hypoglycemia.

Inclusion Criteria:

- Men and women ages 18-65

- BMI 25-40 with a clinical diagnosis of severe symptomatic hypoglycemia after
bariatric surgery

Exclusion Criteria:

- Acute medical illness, such as acute bacterial or viral syndrome, febrile illness,
acute abdominal symptoms, orthopedic injury within one week

- History of cardiac failure, renal insufficiency (estimated Crcl<30cc/min), hepatic
insufficiency, chronic obstructive pulmonary disease, anemia (Hct<30%), or
uncontrolled hypertension (SBP>160 or DBP>100)

- Pregnancy

- Use of medications that affect glucose metabolism

- Fasting glucose >150 or HbA1c>7.5 on Metformin

- Women of childbearing potential (will have a pregnancy test, in addition use of
abstinence for at least one month prior to study or use two types of contraceptives,
hormonal implant or Depo Provera)

- Active, uncontrolled psychiatric disease

- Participating in other studies or have received investigational medications within
the past month or 5 half-lives of the drug, whichever is longer.