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Much attention has been given in the past decades to incretin hormones such as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP), both being gut peptides released from the more proximal small bowel and known to stimulate insulin secretion after a hyperglycemic spike resulting in reactive hypoglycemia.1416 Postprandial hypoglycemia (PPH) occurs more often after bariatric surgery.5,17,18 A recent study that used continuous glucose monitoring (CGM) found a prevalence of PPH after bariatric surgery of up to 50% in patients who had undergone Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy.19 The terms PPH and late dumping are used interchangeably

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In addition to that, tirzepatide influences the expression of microtubule-associated protein 2 (MAP2), growth-associated protein 43 (GAP43), and ATP/GTP binding protein-like 4 (AGBL4), which are involved in neuronal differentiation and synaptic plasticity