Hypoglycemia After Gastric Bypass (RNY) Surgery: Current Concepts, Controversies

southernlady

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https://www.medpagetoday.com/readin...id=NL_ENDORR_2018-08-23&eun=g6050477d47r&pos=

Context

Hypoglycemia, occurring after bariatric and other forms of upper gastrointestinal surgery, is increasingly encountered by clinical endocrinologists. The true frequency of this condition remains uncertain, due, in part, to differences in the diagnostic criteria and in the affected populations, as well as relative lack of patient and physician awareness and understanding of this condition. Postbariatric hypoglycemia can be severe and disabling for some patients, with neuroglycopenia (altered cognition, seizures, and loss of consciousness) leading to falls, motor vehicle accidents, and job and income loss. Moreover, repeated episodes of hypoglycemia can result in hypoglycemia unawareness, further impairing safety and requiring the assistance of others to treat hypoglycemia.

Objective

In this review, we summarize and integrate data from studies of patients affected by hypoglycemia after Roux-en-Y gastric bypass (RYGB) surgery, obtained from PubMed searches (1990 to 2017) and reference searches of relevant retrieved articles. Whereas hypoglycemia can also be observed after sleeve gastrectomy and fundoplication, this review is focused on post-RYGB, given the greater body of published clinical studies at present.

Outcome Measures

Data addressing specific aspects of diagnosis, pathophysiology, and treatment were reviewed by the authors; when not available, the authors have provided opinions based on clinical experience with this challenging condition.

Conclusions

Hypoglycemia, occurring after gastric bypass surgery, is challenging for patients and physicians alike. This review provides a systematic approach to diagnosis and treatment based on the underlying pathophysiology.

The study was funded by the National Institutes of Health, Cincinnati Children's Hospital Clinical Research Center, Mayo Clinic General Clinical Research Center, and Joslin Diabetes Center.

The authors disclosed relevant relationships with Eiger Pharmaceuticals, Novo Nordisk, Eiger Pharmaceuticals, Janssen Pharmaceuticals, Sanofi, Medimmune, Ethicon, and others.
 
this is "dumping", right? or not the same?
Hypoglycemia is more a function of what WLS surgeons call late dumping. It typically happens 1-3 hours after a meal. Usually right around the 2-2 1/2 hour mark. Your blood sugar bottoms out. Similar in many ways to reactive hypoglycemia which is a response to high blood sugar about the 1-1/2 hor mark, and then falls dramatically. But standard hypoglycemia doesn't have the wild swing up first.
 

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