NEW DIFFICULTY IN GASTRIC BYPASS

BOSTON - A least six patients who underwent the most popular type of obesity surgery have developed an apparent complication: blood sugar so perilously low that it causes confusion, tunnel vision and blackouts, doctors say. The condition was corrected with further surgery and no lasting effects, and researchers and other experts said the problem is probably too rare to warrant cutting back on the weight-loss procedure. In fact, the problem might suggest new ways of treating diabetics. "If we can understand the molecular details here, we can bottle them," said Dr. David *******s, a hormone researcher at the University of Washington. He wrote an editorial with the federally funded study in today's New England Journal of Medicine. The possible complication stems from the stomach-bypass procedure known as the Roux-en-Y technique. A small pouch is stapled off from the rest of the stomach and then connected directly to the small intestine. The pouch can handle only small amounts of food. This technique accounts for the vast majority of the roughly 140,000 gastric-bypass operations performed each year in the United States. The number has been rising at almost 50 percent a year in response to the obesity epidemic. Researchers at the Mayo Clinic of Rochester, Minn., focused on six patients who developed severe low blood sugar, or neuroglycopenia. They suffered temporary confusion, passed out or developed tunnel vision after eating. "For people who have it, they basically have to be baby-sat: They cannot be left alone, they can't drive," said one of the researchers, Dr. F. John Service. The researchers suspect the effect happens like this: Barely digested food rushes right into the intestine. Its hormones then over stimulate the insulin-oozing beta cells of the pancreas. The excess of insulin - the same hormone that fails in diabetics - removes too much sugar from the blood. To correct the condition, doctors had to remove most of the pancreas from the patients. But that put the patients in danger of developing diabetes, an illness that is often cured by gastric-bypass surgery. Dr. Neil Hutcher, president of the American Society for Bariatric Surgery, said he has never seen the possible complication in his roughly 3,000 operations. "Do I think it can be called a substantial complication of gastric bypass at this time? Absolutely not. Do I think it's a reason to modify gastric bypass at this time.

My question is, HOW CAN LOW BLOOD SUGAR also known as NEUROGLYCOPENIA BE PREVENTED IN GASTRIC BYPASS PATIENTS!?  Is that even possible? Or do all RNY patients just have to hope and pray that’s not a complication they will encounter? Can someone PLEAES shed some light on this issue!

hard to answer that question. every patient has there own set of reactions to this surgery, as a matter of fact, any kind of surgery. its hard to generalize. ive been ok with blood sugar, im 20 months out now.  however, i just developed low iron which im now taking a supplement for. i think we all need to do what our docs tell us and just take one day at a time.  i would do this surgery again in a hearbeat. hugs, jacki

Well, I know at first I had to really keep an eye on my blood sugar, and make sure I ate regularly. I don't even have to test it - I KNOW when mine is low.  Also, my daughters have learned to recognize when I need to eat -  I get grumpy, confused, out of sorts.  It doesn't seem to be too much of a problem anymore, but I would say the first year I had to watch it. By the way, about 5 years before I had my WLS, I was diagnosed with Type 2 diabetes. My blood sugar was over 600. Now, with NO meds, I hover around 87. My A1c is about 5.1.  Yay for WLS!!!

I'm one of those with reactive hypoglycemia. I was diagnosed with diabetes just before my RNY nearly 2 years ago. I have to eat every 2-3 hours or I'll start bottoming out, especially if I'm active. Sometimes I wake up during the night and I feel like it's low, and I'll eat 1/2 peanut butter sandwich on wheat bread. (That seems to keep me level better than anything.) Mine isn't so bad I can't work or drive, and I sure hope it never gets that bad, it's just something I have to tend to. I'm a little disappointed that I'm not "perfect" since I've lost all this weight, but overall I'm a lot healthier than I used to be.

Melting Mama suffers with this to a huge degree that she is not able to drive, etc.  She has several doctors on her case all trying to figure out how to keep her out of harm's way.  You may want to look up her profile and she also has her own daily blog.  She's a good writer, intelligent, whitty, charming, well informed, and an avid researcher! I'm on a computer other than mine so I don't have her links handy but you should be able to find her relatively easily; if not, get back to me and I'll get them to you later!

Got it!!! Beth aka "MM" http://meltingmama.typepad.com/wls http://meltingmama.typepad.com/weighty_secrets

I am a 24 month post op RNY patient *****mains an insulin dependent diabetic.  My a1c is less than half what it was prior to surgery.  For all effects, I am a poster child for RNY for diabetics (Doctor's quote). Yes, low blood sugar happens.  It happens to MILLIONS of people in a variety of cir****tances.  As with any cir****tance, you must be your own health care advocate. Seek professional assistance when needed.  Educate yourself in regard to symptoms.  Educate folks around you who can help spot issues or know the solution once the effects incapacitate you. IN MY OWN LIFE:  I most often bottom out under two cir****tances.  Right after my menstrual cycle when my body is readjusting to the hormone changes and when I eat too much of something high glucose based and my sugar spikes then bottoms out.  I have the double edge sword in that I need insulin daily.  When either of these two cirucmstances occur, I am careful to be more on guard.   After twenty years as a type 2 diabetic, I am pretty good at knowing my body and how it reacts.  I always carry peanut butter crackers on me for emergencies.  I also have a very small blood glucose meter in my purse for testing.  (My main meter is at home for history). For every WLS patient, there as just as many possible cir****tances for health issues.  It remains the best decision I ever made for my own health.  Risks known and accepted.  I am in this new body for the long haul!! Vicky

I was not diabetic before the surgery and I have these episodes.  I stumble like I'm drunk and have no clue what is going on.  All of a sudden I feel super warm, feel like I'm going to puke and sometimes just pass out.  I think its time to call the doc.  Thanks for this article.

I have these same issues .. I had RNY Sept '03 and started having seizures in '05 .. I have had 6 to date and they are all due to having reactive hypoglycemia .. it is due to the surgery .. my blood sugar has dropped as low as 27 and so I have to check myself sometimes even though I can already tell when it is dropping .. right now there is nothing that I can do for it except try to eat several times a day and I do see an endocronologist for it .. and yes it can be scary but ya get used to it .. or I guess I have or I have told myself I have .. smile ..

Also, as stated VERY RARE. Also, study does not state all factors.  How do we know that these people did what they should have? To me it sounds as if you don't have peace to get the surgery so you shouldn't until you do have peace.  Studies that don't include ALL factors should be discarded.  Remember the "don't eat eggs they are bad for you?" and now it's "eat eggs 2-4 a week".  They first said bad due to cholestoral, now they are good even tho they are still high in cholestoral because they have other healthy benefits.  I consider these studies you have posted about in such ways.