A patient with a history of gastric surgery may develop symptoms several hours after eating. Although sometimes referred to as the late dumping syndrome, diarrhea is not a feature.
Mechanism: A large amount of carbohydrates are released into the proximal small bowel where they are rapid absorbed and cause hyperglycemia, This triggers a release of insulin, which results in subsequent hypoglycemia.
Onset: 1.5-3 hours after eating
Clinical findings:
(1) diaphoresis
(2) tremulousness
(3) lightheadedness, faintness
(4) tachycardia or palpitations
(5) confusion
(6) weakness
(7) anxiety
An oral glucose tolerance test can be done, which will show the peak in glucose, surge in insulin release and subsequent hypoglycemia.
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