Algorithm to diagnose etiology of hypoglycemia after Roux-en-Y gastric bypass for morbid obesity: case series and review of the literature

Ceppa, Eugene P.; Ceppa, DuyKhanh P.; Omotosho, Philip; Dickerson, James A.; Park, Chan W.; Portenier, Dana

doi:10.1016/j.soard.2011.08.008

Cited by 51 publications

(38 citation statements)

References 41 publications

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“…However, it is essential to rule out other causes of hyperinsulinemic hypoglycemia like factitious insulin administration [41,42] or nesidioblastosis. Ceppa et al [43] published an algorithm by including OGTT, C-peptide, proinsulin levels and a 72 hour fasting test. Also, one case of an insulinoma [44] was observed after RYGB, leading to recurrent hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

Hypoglycemia after Roux-En-Y gastric bypass: detection rates of continuous glucose monitoring (CGM) versus mixed meal test

Kefurt

Langer

Schindler

et al. 2015

Surgery for Obesity and Related Diseases

115

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Section: Discussionmentioning

confidence: 99%

Hypoglycemia after Roux-En-Y gastric bypass: detection rates of continuous glucose monitoring (CGM) versus mixed meal test

Kefurt

Langer

Schindler

et al. 2015

Surgery for Obesity and Related Diseases

115

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“…The effectiveness of octreotide, at the initial recommended dose of 25-50 µg administered subcutaneously 2-3 times daily and 15-30 min before meals, in ameliorating symptoms of dumping is supported by several randomised trials [23], and this drug may be therefore helpful in some patients [4]. However, in case of severe hypoglycaemic events with neuroglycopenic symptoms, alternative causes of hyperinsulinaemic hypoglycaemia (pancreatic beta-cells hyperplasia, insulinoma) should be considered and specific diagnostic algorithms have been proposed [24]. …”

Section: Nutritional Managementmentioning

confidence: 99%

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

et al. 2017

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Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations.

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“…Criteria for assessment of effect of bariatric surgery on optimization of metabolic status and some other co-morbid conditions [58] : -HbA1c ≤ 6%, no hypoglycaemia, total cholesterol < 4 mmol/l, LDL-cholesterol < 2 mmol/l, triglycerides < 2.2 mmol/l, blood pressure < 135/85 mmHg, >15% weight loss, or lowering of HbA1c by >20%, LDL< 2.3 mmol/l, blood pressure < 135/85 mm Hg with reduced medication from pre-operative status. In cases of postprandial hypoglycaemic symptoms, evidence for lowered blood glucose concurrent with symptoms should be looked for; patients should first be advised on dietary changes (low carbohydrate diets, regular meal times); second-line drug treatment may be considered, such as acarbose, calcium-channel antagonists, diazoxide, octreotide (EL C [188][189][190][191][192] .) Special care must be taken for: -The possible nutritional deficiencies such as vitamin, protein and other micronutrients.…”

Section: Follow-upmentioning

confidence: 99%

Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery

et al. 2013

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In 2012, an outstanding expert panel derived from IFSO-EC (International Federation for the Surgery of Obesity -European Chapter) and EASO (European Association for the Study of Obesity), composed by key representatives of both Societies including past and present presidents together with EASO's OMTF (Obesity Management Task Force) chair, agreed to devote the joint Medico-Surgical Workshop of both institutions to the topic of metabolic surgery as a pre-satellite of the 2013 European Congress on Obesity (ECO) to be held in Liverpool given the extraordinarily advancement made specifically in this field during the past years. It was further agreed to revise and update the 2008 Interdisciplinary European Guidelines on Surgery of Severe Obesity produced in cooperation of both Societies by focusing in particular on the evidence gathered in relation to the effects on diabetes during this lustrum and the subsequent changes that have taken place in patient eligibility criteria. The expert panel composition allowed the coverage of key disciplines in the comprehensive management of obesity and obesity-associated diseases, aimed specifically at updating the clinical guidelines to reflect current knowledge, expertise and evidence-based data on metabolic and bariatric surgery.

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Algorithm to diagnose etiology of hypoglycemia after Roux-en-Y gastric bypass for morbid obesity: case series and review of the literature

Cited by 51 publications

References 41 publications

Hypoglycemia after Roux-En-Y gastric bypass: detection rates of continuous glucose monitoring (CGM) versus mixed meal test

Hypoglycemia after Roux-En-Y gastric bypass: detection rates of continuous glucose monitoring (CGM) versus mixed meal test

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery

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