Medical nutrition therapy for post-bariatric hypoglycemia: practical insights

Suhl, Emmy; Anderson-Haynes, Sue-Ellen; Mulla, Christopher M.; Patti, Mary‐Elizabeth

doi:10.1016/j.soard.2017.01.025

Cited by 70 publications

(69 citation statements)

References 43 publications

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“…Diet is the cornerstone of therapy for post-RYGB hypoglycemia ( Fig. 4) and is aimed at reducing the stimulus for glycemic spikes and insulin secretion [general clinical approach reviewed in Suhl et al (41)]. Unfortunately, there are no well-designed studies comparing the long-term impact of meal plans with different nutrients and/or macronutrient composition.…”

Section: Medical Nutrition Therapymentioning

confidence: 99%

Hypoglycemia After Gastric Bypass Surgery: Current Concepts and Controversies

Salehi

Vella

McLaughlin

et al. 2018

The Journal of Clinical Endocrinology &Amp; Metabolism

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178

185

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Section: Medical Nutrition Therapymentioning

confidence: 99%

Hypoglycemia After Gastric Bypass Surgery: Current Concepts and Controversies

Salehi

Vella

McLaughlin

et al. 2018

The Journal of Clinical Endocrinology &Amp; Metabolism

Self Cite

178

185

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“…Most studies were largely focused on postoperative hypoglycemia. 15,16 A recent longitudinal study by Jakobsen et al, 10 which followed a bariatric surgery patient cohort (n = 1888) for 6 years post operation, did not report OI as a significant adverse event. Instead, the study largely focused on medications prescribed and procedures done to examine adverse events related to surgical complications, re-interventions, malnutrition, nausea, vomiting, and hypoglycaemia.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have explored the long‐term postoperative consequences of bariatric surgery outside of weight loss. Most studies were largely focused on postoperative hypoglycemia . A recent longitudinal study by Jakobsen et al, which followed a bariatric surgery patient cohort (n = 1888) for 6 years post operation, did not report OI as a significant adverse event.…”

Section: Discussionmentioning

confidence: 99%

The incidence of orthostatic intolerance after bariatric surgery

Zhang

Tamboli

Albaugh

et al. 2019

Obesity Science & Practice

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Summary Aims Every year, over 200 000 individuals undergo bariatric surgery for the treatment of extreme obesity in the United States. Several retrospective studies describe the occurrence of orthostatic intolerance (OI) syndrome after bariatric surgery. However, the incidence of this syndrome remains unknown. Materials and methods We used a prospective, de‐identified registry of 4547 patients who have undergone bariatric surgery at Vanderbilt to identify cases of new‐onset OI. Structured chart reviews were conducted for all subjects who reported new‐onset OI post surgery. Cases of OI were confirmed using an operational case definition developed by the Vanderbilt Autonomic Dysfunction Center, and autonomic function tests results were examined for evidence of impaired autonomic function. The cumulative incidence of post‐bariatric surgery OI syndrome was estimated using a life table. Results Seven hundred forty‐one of 4547 (16.3%) patients included in our cohort reported new OI symptoms after surgery. After the chart review, we confirmed the presence of post–bariatric surgery OI syndrome in 85 patients, 14 with severe OI requiring pressor agents. At 5 years post surgery, follow‐up is reduced to 15%; the unadjusted 5‐year prevalence of OI was 1.9%. The cumulative incidence of OI syndrome adjusted for loss of follow‐up was 4.2%. Most OI cases developed during weight‐stable months (±5 kg). At the time of identification, 13% of OI cases showed evidence of impaired sympathetic vasoconstrictor activity. Conclusion OI is frequent in the bariatric population, affecting 4.2% of patients within the first 5 years postoperatively. In 13% of post–bariatric surgery OI patients, there was evidence of impaired sympathetic vasoconstriction activity.

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“…Blood glucose levels should be regularly checked and kept within normal limits, with medication adjustment as needed. Other strategies focus on diet and lifestyle interventions . First, carbohydrates should be portioned at 30 g per meal and 15 g per snack.…”

Section: Discussionmentioning

confidence: 99%

“…Other strategies focus on diet and lifestyle interventions. 22 First, carbohydrates should be portioned at 30 g per meal and 15 g per snack.…”

Section: Discussionmentioning

confidence: 99%

Glycemic Management in the Bariatric Surgery Population: A Review of the Literature

2018

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Obesity is a worldwide epidemic often complicated by multiple comorbidities, including type 2 diabetes mellitus (T2DM). Bariatric surgery is an increasingly common and effective weight-loss strategy for obese patients that may result in resolution of metabolic-related disease states, such as T2DM. Although bariatric surgery has many positive outcomes for patients, dietary and pathophysiologic changes can create difficult-to-control blood glucose, especially in the immediate perioperative setting. Depending on oral antidiabetic agent and insulin needs preoperatively, many patients require cessation of oral agents and reduction or cessation of insulin. Unfortunately, despite available perioperative bariatric surgery guidelines, no specific recommendations for perioperative oral antidiabetic agent or insulin management exist. The purpose of this article is to review the current body of evidence for blood glucose management in the setting of bariatric surgery. An English-language PubMed and MEDLINE search was conducted from 1964 through March 2018 using the following search terms alone and in various combinations: bariatric surgery, gastric banding, laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), glucose management, insulin, and oral antidiabetic agent. Five articles were identified evaluating insulin management in the perioperative bariatric surgery setting, which were separated into two categories: immediate perioperative insulin management and long-term postoperative insulin management. Overall, various blood glucose management insulin protocols were evaluated. All studies included some type of insulin reduction in the perioperative setting. No studies identified specifically evaluated down-titration or discontinuation of oral antidiabetic agents. Given the lack of specific guideline recommendations, limitations of standardized insulin protocols, and inconsistency of outcomes studied, perioperative insulin at reduced doses compared to previous maintenance doses coupled with frequent blood glucose monitoring is reasonable. An opportunity exists for successful protocols to be addressed in future, larger studies.

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Medical nutrition therapy for post-bariatric hypoglycemia: practical insights

Cited by 70 publications

References 43 publications

Hypoglycemia After Gastric Bypass Surgery: Current Concepts and Controversies

Hypoglycemia After Gastric Bypass Surgery: Current Concepts and Controversies

The incidence of orthostatic intolerance after bariatric surgery

Glycemic Management in the Bariatric Surgery Population: A Review of the Literature

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