Hypoglycemia information for all-xpost

Some folks have written about developing hypoglycemia after their surgery. I had my RnY in May, and only heard about the possibility of developing hypoglycemia a few days before my surgery. My husband is an endocrinologist with several patients & staff (plus me) who have had wls. He is concerned about the possibility of hypoglycemia and has been following the published medical literature about it. He wrote the following up and gave me permission to post it to this list, hoping that it might be helpful. It might be useful to print it out and show it to your doctor if this is something that you might be developing. This certainly should not be used as a medical diagnosis; only your doctor will be able to do that accurately. Therese *****

Hypoglycemia can complicate gastric bypass surgery (GBS) for a small fraction of patients. Until recently the only reported remedy was partial pancreatectomy, the hypothesis being that increased secretion of incretins (intestinal hormones that stimulate insulin secretion) had caused overgrowth (hyperplasia) of the beta cells that secrete insulin. 

However, researchers in Los Angeles have shown that hypoglycemia after bypass surgery is NOT always accompanied by islet cell overgrowth (1). 

Furthermore, a couple of other possible treatments have recently been reported. 

First, a group in Minneapolis (2) showed that hypoglycemia in three affected patients developed only after a high carbohydrate meal, which ran blood sugar up over 200 mg/dL and released very large amounts of insulin, which then pulled the blood sugar down too far. In contrast, low carbohydrate test meals did not produce much change in insulin or blood sugar. 

Second, and most importantly, a Swiss team (3) observed that severe, disabling hypoglycemia after GBS occurred only in patients with with loss of restriction of the gastric pouch. They reported on 10 consecutive patients, of whom 9 were  cured simply by surgical placement of a silastic ring or adjustable gastric band around the pouch. Only one patient failed to respond to re-establishing pouch restriction, and had to undergo distal pancreatectomy after all. The followup period was 5 to 19 months. There was no mortality and only 1 patient had any morbidity. 

These measures may not always work, but they should certainly be tried before resorting to surgery on the pancreas. There is also a medication that inhibits insulin secrtion, diazoxide, which could also be tried as well. 

References.

1.  Diabetes Care. 2006 Jul;29(7):1554-9. Hyperinsulinemic hypoglycemia after gastric bypass surgery is not accompanied by islet hyperplasia or increased beta-cell turnover. Meier JJ, Butler AE, Galasso R, Butler PC. Larry Hillblom Islet Research Center, UCLA David Geffen School of Medicine, 24-130 Warren Hall, 900 Veteran Ave., Los Angeles, CA 90095-7073, USA.

2. Obes Surg. 2007 May;17(5):592-4. Hyperinsulinemic hypoglycemia developing late after gastric bypass. Bantle JP, Ikramuddin S, Kellogg TA, Buchwald H. Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.

3.Obes Surg. 2008 Apr 26. [Epub ahead of print]. Severe Recurrent Hypoglycemia after Gastric Bypass Surgery. Z'graggen K, Guweidhi A, Steffen R, Potoczna N, Biral R, Walther F, Komminoth P, Horber, F. Berner Viszeralchirurgie and Schweizerisches Pankreaszentrum Klinik Beau-Site Bern, Bern, Switzerland.

Lawrence E. Mallette, MD, PhD

June 24, 2008

Dear Jay, I do not know the answer to your question, unfortunately. My husband was specifically researching gastric bypass surgery. Show this info to your surgeon and maybe you will get a better answer. Therese

Hi Amarilli59, I was very excited to read your post.  I had my surgery on August 29, 2007 and have lost 136 pounds.  When my weight was in the 130's I started with low blood sugars and have been fighting the battle since.  I have spoken with the NUT and have been trying to follow the several small meals, complex carbs, etc.  but what I have found is that when I am stressed my BS drop, when I eat fruit my BS drop, sometimes my BS just drop.  I go to Curves 5-6 days a week and walk daily.  I will be seeing my surgeon on July 21st and will address it again with her but I am concerned because at times my BS drops to 43 and somedays I feel like that is all I am doing is chasing low BS and eating to the point of frustration. I am an RN in the critical care area so I am aware of the seriousness of all of this but I am not a NUT or doctor and I am so frustrated, worried, and concerned.  thanks for your posting and listening to me vent.  Any input you have would be greatly appreciated.   Thanks Karen Schworm

Dear Karen, I hope my husband's information will be of some help. Be sure to take a copy of his analysis with you when you go to your doctor. If you would like to know more about my husband, just google his name; he trained at Vanderbilt, did a fellowship at Johns Hopkins & the NIH, so he is pretty well respected. Good luck with your quest for health!!! Therese

Thank you for posting this, Therese.  I am hoping to avoid pancreatic surgery.

I just finished listening to your videos, and I hope and pray that you can avoid pancreatic surgery. My husband listened to it with me, and we both hope that what he wrote is of some help to you. Please let me know, if you can. Therese

My goodness is this a blessing to see... I am 4 1/2 years out of GBS lost over 150lbs.... have been battling hypoglycemia since November 2005. All doctors told me I was crazy until my blood sugar went from 310 to 23 in less than 3 hours (Feb 2008). I was than hospitalized for several days....and again 3 more hospitalization after that with my most recent blood sugar level bottoming out at 19.  I am currently seeking medical attention at Shand's Hospital in Gainesville FL.  They are preparing to preform the partial pancreas surgery.  I have since lost my job of 81/2 years and been placed on long term disability at the age of 30.  All due to the extreme problems that have NOT been resolved with diet nor 2 different medications (ACARBOSE & JANUVIA).  I live hour to hour wondering when my next episode will happen.... There is NO telling when or what really triggers my episodes because it has happened after eating straight protien (plain chicken or salad ....no dressing). This complication has caused emotional and physical depression to the point I wish I would never wake up somedays.  I maintained my weight of 127-135 for over 3 years then gained over 40 lbs in less than 3 months (MY EATING HAS NOT CHANGED) now the doctors are stating it is due to the hypoglycemia reactive..... Was the GBS all worth in? I don"t think so now....Will I ever lose the weight and live a health life after this pancreas surgery? I am so scared....please help

I certainly can understand your fears!!!!
Have you shown my husband's information to your doctors yet?
Therese

Thank you.... yes I just emailed and called my Endocrinolgist (Dr. Maria Lansang, Shand's Medical Hospital, Gainesville FL) with your husband's articles... Please feel free to call me 603-321-6360. I would love to get more insite ASAP as I want to live a HAPPIER and HEALTHIER life :)