&lt;p&gt;Hypoglycemia After Upper Gastrointestinal Surgery: Clinical Approach to Assessment, Diagnosis, and Treatment&lt;/p&gt;

Sheehan, Amanda; Patti, Mary Elizabeth

doi:10.2147/dmso.s233078

Cited by 24 publications

(20 citation statements)

References 106 publications

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“…Management and treatment may be aided by novel interventions, such as continuous glucose monitoring, which could be a useful tool in the diagnosis and management of reactive hypoglycaemia [96]. It may also facilitate strategies to reduce the impact of dumping on HRQL, especially social and cognitive function [97].…”

Section: Discussionmentioning

confidence: 99%

The impact of Nutrition and Gastrointestinal Symptoms on Health-related Quality of Life in Survivorship after Oesophageal Cancer Surgery

Bennett

Murphy

Fanning

et al. 2022

Clinical Nutrition Open Science

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Background and Aims: Oesophagectomy is the primary curative treatment for oesophageal cancer but is associated with considerable postoperative morbidity and mortality. To better understand the aetiology of impaired health-related quality of life (HRQL) in oesophageal cancer survivors (OCS), this study sought to determine the longitudinal changes in nutritional status, nutritionimpact symptoms (NIS), and HRQL in this cohort, and to determine which variables have the greatest impact on postoperative HRQL decline. Methods: Data, derived from St. James' Hospital, Dublin, included patients who underwent oesophagectomy from October 2017 to May 2019 and attended clinic preoperatively and 6 months postoperatively. A subset attended a further 12-month appointment. HRQL and symptom data were collected using validated questionnaires and anthropometric measures were completed by clinicians. Data were analysed using SPSS. Results: A total of 66 patients were studied preoperatively and 6 months postoperatively, of whom 37 were studied at 12 months postoperatively. Malnutrition remained prevalent at each timepoint, although rates did not significantly change longitudinally. Conversely, the prevalence of malabsorption (7.6%e14.3%, Abbreviations: HRQL, Health-related quality of life; NIS, Nutrition-impact symptoms; OC, Oesophageal Cancer.

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Section: Discussionmentioning

confidence: 99%

The impact of Nutrition and Gastrointestinal Symptoms on Health-related Quality of Life in Survivorship after Oesophageal Cancer Surgery

Bennett

Murphy

Fanning

et al. 2022

Clinical Nutrition Open Science

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“…In a stepwise manner, biochemical analysis must be performed to rule out other causes[ 18 ]. Plasma glucose, insulin, C-peptide, proinsulin, beta-hydroxybutyrate, and cortisol levels should be measured.…”

Section: Discussionmentioning

confidence: 99%

“…Plasma glucose, insulin, C-peptide, proinsulin, beta-hydroxybutyrate, and cortisol levels should be measured. The development of provocative studies such as a 72-h fasting test is also recommended[ 10 , 18 ]. The goal is to determine whether beta-cell peptides are appropriately suppressed during hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

Insulinoma after sleeve gastrectomy: A case report

Lobaton-Ginsberg¹,

Sotelo-González²,

Ramírez‐Rentería³

et al. 2022

WJCC

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BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has been proposed as an effective and durable treatment for severe obesity and glucose metabolism disorders, and its prevalence has increased from 5% to 37% since 2008. One common complication after bariatric surgery is a postprandial hyperinsulinemic hypoglycemic state. While rare, insulinomas can cause this state, where symptoms are more common in the fasting state; thus, evaluation of insulin secretion is needed. Until now, there have been no reports of insulinoma after LSG. CASE SUMMARY We describe the case of a 43-year-old woman who was referred to the obesity clinic 2 years after LSG was performed. She had symptoms of hypoglycemia predominantly in the fasting state and documented hypoglycemia of less than 30 mg/dL, which are compatible with Whipple’s triad. Initially, dumping syndrome was suspected, but after a second low fasting plasma glucose was documented, a 72-h fasting test was performed that tested positive. Computed tomography and endoscopic ultrasound were performed, identifying the presence of a homogeneous hypoechoic semioval tumoral lesion in the pancreas. The diagnosis was compatible with insulinoma. After laparoscopic enucleation of the insulinoma, the symptoms and hypoglycemia disappeared. The histopathological report described a well-differentiated grade 2 neuroendocrine tumor with positive chromogranin and synaptophysin and Ki67 immunopositivity in 4% of the neoplastic cells. CONCLUSION Insulinoma after LSG is a rare condition, and clinicians must be aware of it, especially if the patient has hypoglycemic symptoms during the fasting state.

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“…Altered nutrient delivery is reported to be closely related to postprandial GLP-1 increase, which is upregulated over 10-fold after RGYB in symptomatic patients with post-bariatric hypoglycemia [47]. Elevated GLP-1, together with high glucose, leads to significant insulin release and subsequent rapid drop in plasma glucose levels after meals [46]. Intriguingly, GLP-1 receptor antagonist exendin (9-39) normalizes insulin secretion and prevents hypoglycemia during an oral glucose tolerance test in patients with confirmed post-bariatric hypoglycemia [26].…”

Section: The Mechanisms Of Hypoglycemiamentioning

confidence: 99%

“…Intestine-specific mechanisms may play an essential role in hypoglycemia [46]. Particularly, exaggerated secretion of GLP-1 is considered a critical factor [26].…”

Section: The Mechanisms Of Hypoglycemiamentioning

confidence: 99%

Novel Insight into the Mechanism of Metabolic Surgery Causing the Diversity in Glycemic Status in Type 2 Diabetes

Zhou

Wang

Zhou

et al. 2022

Exp Clin Endocrinol Diabetes

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Metabolic surgery results in diverse glycemic status in patients with type 2 diabetes (T2D), including hyperglycemia without remission, significant amelioration of hyperglycemia with partial remission, complete restoration of euglycemia, or with prolonged remission, hyperglycemia recurrence in relapses after remission, or post-bariatric hypoglycemia. Unfortunately, it is not known how metabolic surgery leads to this diverse consequence. Here, we discuss the diversity of glycemic status associated with metabolic surgery and the potential mechanisms of T2D remission. We also highlight the relationship between the change in low-grade inflammation and T2D remission after metabolic surgery. We hypothesize that the level of inflammatory and anti-inflammatory cytokines controls the efficacy of metabolic surgery in patients with T2D. This hypothesis may provide further insight into the mechanism of the beneficial effects of metabolic surgery patients with T2D.

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<p>Hypoglycemia After Upper Gastrointestinal Surgery: Clinical Approach to Assessment, Diagnosis, and Treatment</p>

Cited by 24 publications

References 106 publications

The impact of Nutrition and Gastrointestinal Symptoms on Health-related Quality of Life in Survivorship after Oesophageal Cancer Surgery

The impact of Nutrition and Gastrointestinal Symptoms on Health-related Quality of Life in Survivorship after Oesophageal Cancer Surgery

Insulinoma after sleeve gastrectomy: A case report

Novel Insight into the Mechanism of Metabolic Surgery Causing the Diversity in Glycemic Status in Type 2 Diabetes

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