JCEM case reportsSep 4, 2026

Tirzepatide treatment for low blood sugar after gastric bypass surgery: 3 case reports

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Sep 5, 2026

Abstract

Three patients with postbariatric hypoglycemia (PBH) experienced improved symptoms after treatment with tirzepatide.

All patients had episodes of low blood sugar after meals, accompanied by symptoms such as sweating, vision problems, and confusion.
Previous treatments, including dietary changes and medications, were either not fully effective or caused side effects.
Treatment with tirzepatide resulted in longer periods of stable blood sugar levels and fewer, less severe hypoglycemic episodes.
Glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide receptor agonists may help manage PBH, but more research is needed to confirm this and determine the best dosing.

Simplified

Postbariatric hypoglycemia (PBH) represents a challenging complication of bariatric surgery. This case series describes 3 patients with PBH following Roux-en-Y gastric bypass who were treated with tirzepatide, a glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist (RA). All patients presented with symptomatic hypoglycemia characterized by episodes of diaphoresis, visual disturbances, confusion, and documented low blood glucose levels occurring postprandially. Conventional management strategies, including dietary modifications, acarbose, and other pharmacotherapies, were either partially effective or limited by side effects. Initiation of tirzepatide led to increased time in range, reduced number and severity of hypoglycemic episodes, and decreased glucose variability. This report suggests that GLP-1 and GIP RA can be a promising adjunct in managing PBH; however, further studies to confirm their efficacy and establish optimal dosing strategies are needed.

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Tirzepatide treatment for low blood sugar after gastric bypass surgery: 3 case reports

Abstract

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