• Time from dasiglucagon administration to recovery (first plasma glucose value above the fasting plasma glucose level [ Time Frame: Two hundred forty minutes ]
  Time from dasiglucagon administration to recovery (first plasma glucose value above the fasting plasma glucose level
• Time in hypoglycaemia (plasma glucose concentration <3.9 mmol/l) from study drug administration until 240 minutes [ Time Frame: Two hundred forty minutes ]
  Time in hypoglycaemia
• Time below fasting plasma glucose level from study drug administration until two hundred forty minutes [ Time Frame: Two hundred forty minutes ]
  Time below fasting plasma glucose level
• Area 1: the area above the glucose curve and below the fasting level from the time of study drug administration until glucose values reach the fasting level. [ Time Frame: Two hundred forty minutes ]
  Area 1
• Area 2: the area below the glucose curve and above the fasting level from the time glucose values reach the fasting level until 240 minutes. [ Time Frame: Two hundred forty minutes ]
  Area 2
• Edinburgh Hypoglycaemia Symptom Scale (EHSS) responses of the Edinburgh Hypoglycaemia Symptom Scale (EHSS) and early dumping symptoms based on [ Time Frame: t=zero to t=Two hundred forty minutes ]
  likert scale one (absent) to seven (severe)
• The Dumping Severity Score (DSS). [ Time Frame: t=zero to t=Two hundred forty minutes ]
  likert scale, zero (absent) to three (severe)
• Frequency and severity of adverse events and serious adverse events recorded during the meal test [ Time Frame: from t= minus thirty to t=Two hundred forty minutes ]
  Frequency

• Time from dasiglucagon administration to recovery (first plasma glucose value above the fasting plasma glucose level [ Time Frame: Two hundred forty minutes ]
  Time from dasiglucagon administration to recovery (first plasma glucose value above the fasting plasma glucose level
• Time in hypoglycaemia (plasma glucose concentration <3.9 mmol/l) from study drug administration until 240 minutes [ Time Frame: Two hundred forty minutes ]
  Time in hypoglycaemia
• Time below fasting plasma glucose level from study drug administration until two hundred forty minutes [ Time Frame: Two hundred forty minutes ]
• Area 1: the area above the glucose curve and below the fasting level from the time of study drug administration until glucose values reach the fasting level. [ Time Frame: Two hundred forty minutes ]
  Area 1
• Area 2: the area below the glucose curve and above the fasting level from the time glucose values reach the fasting level until 240 minutes. [ Time Frame: Two hundred forty minutes ]
  Area 2
• Edinburgh Hypoglycaemia Symptom Scale (EHSS) responses of the Edinburgh Hypoglycaemia Symptom Scale (EHSS) and early dumping symptoms based on [ Time Frame: t=zero to t=Two hundred forty minutes ]
  likert scale one (absent) to seven (severe)
• The Dumping Severity Score (DSS). [ Time Frame: t=zero to t=Two hundred forty minutes ]
  likert scale, zero (absent) to three (severe)
• Frequency and severity of adverse events and serious adverse events recorded during the meal test [ Time Frame: from t= minus thirty to t=Two hundred forty minutes ]
  Frequency

The Roux-En-Y gastric bypass (RYGB) has major health-promoting effects - reversing type-2-diabetes, improving dyslipidemia and inducing robust weight loss. However, several RYGB-individuals, post surgery, suffers from dumping syndrome and postprandial hyperinsulinemic hypoglycemia (PHH) due to the anatomical rearrangement of the gastro-intestinal system. Dasiglugaon (also known as (ZP4207) has shown great pharmacokinetic- and dynamic effects, compared to other glucagon analogues on the market, when administrated to hypoglycemic type-1-diabetics.

Therefore we aim to examine the effects of two different doses of dasiglucagon on the postprandial nadir plasma glucose concentration in RYGB-operated individuals suffering from PHH by use of a mixed meal test (MMT).

The study is designed as a double-blinded, randomised, 3-period, 3-treatment, crossover study comprising 3 separate treatment days in which participants will undergo an MMT along with one of the following double-blinded interventions:

1. Subcutaneous (sc) placebo (saline) injection
2. Sc injection with 80 μg dasiglucagon
3. Sc injection with 200 μg dasiglucagon

• Hyperinsulinemic Hypoglycemia
• Postprandial Hypoglycemia

• Drug: ZP4207
  Abdominal SC administration
  Other Name: Dasiglucagon
• Other: Placebo (saline)
  Abdominal SC administration

• Experimental: 80 ug of sc dasiglucagon
  80 ug of dasiglucagon in a 0.4 mL fluid (saline) is injected abdominal subcutaneous postprandial prior to hypoglycemia.
  Intervention: Drug: ZP4207
• Experimental: 200 ug of sc dasiglucagon
  200 ug of dasiglucagon in a 0.4 mL fluid (saline) is injected abdominal subcutaneous postprandial prior to hypoglycemia.
  Intervention: Drug: ZP4207
• Placebo Comparator: 0.4 mL of sc saline (placebo)
  0.4 mL fluid (saline/placebo) is injected abdominal subcutaneous postprandial prior to hypoglycemia.
  Intervention: Other: Placebo (saline)

Inclusion Criteria:

• Documented postprandial hypoglycaemia (<3.9 mmol/l) by 6-day CGM or during a MMT
• Documented plasma glucose concentration excursions >5.0 mmol/l by 6-day CGM or a MMT
• Haemoglobin levels for women >7.3 mmol/l and for men >8.3 mmol/l
• Ferritin >10 μg/l
• Cobalamin >150 pmol/l
• Fasting plasma glucose concentration within the range of 4.0-6.0 mmol/l CKN-DASI-RYGB protocol version 1.0 6
• Normal electrocardiogram (ECG)
• Negative urine human chorionic gonadotropin (hCG) (for fertile women)

Exclusion Criteria:

• Treatment with medication(s) affecting insulin secretion or any antidiabetic drugs
• Treatment with antipsychotics
• Current participation in another clinical trial with administration of investigational drug.
• Previous exposure to dasiglucagon (otherwise known as ZP4207)
• History of liver disease that is expected to interfere with the anti-hypoglycaemic action of glucagon (e.g. liver failure or cirrhosis).
• Pregnancy
• Breastfeeding
• Any factors that, in the opinion of the site principal investigator or clinical protocol chair, would interfere with the safe completion of the study, including medical conditions that may require hospitalization during the trial or allergy to the ingredients in the study drug.