Hypoglycemia Following Bariatric Surgery: Our 31-Year Experience

Abstract

Purpose Identify the cumulative incidence of post-bariatric surgery hypoglycemia (PBSH), describe its symptomatology, and characterize treatment patterns at a large academic institution. Materials and Methods All patients who underwent bariatric surgery at a single institution from 1985–2015 were identified using a clinical database, administrative billing data identified patients who were treated for hypoglycemia, and chart reviews were performed to make a diagnosis of PBSH based on Whipple’s triad. PBSH cases were reviewed including patient diabetes history, symptomatology, and treatment measures. Univariate analyses were performed to identify correlations based on symptomatology, laboratory values, and treatments utilized. Results Ninety (2.6%) of 3,487 patients were diagnosed with PBSH with preoperative median age of 43 years, mean BMI of 50.0 kg/m2, and median glycated hemoglobin of 6.0%. Median time-to-first hypoglycemic event was 40.6 months. No factors were identified which predict symptom severity or resolution. The 24 (27%) patients who received pharmacotherapy to treat hypoglycemia were younger, had lower nadir blood glucose levels, and more frequent symptoms. Sixty-nine (79%) cases eventually resolved. Conclusions PBSH onset and severity are highly variable. Successful management of these patients can prove difficult and should include dietary therapy, the selective use of pharmacotherapy and surgery, and the use of a multidisciplinary team including bariatric surgeons and endocrinologists.

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

“…A low‐carbohydrate, low‐glycemic index diet with adequate protein and inclusion of heart‐healthy fats along with restricting alcohol and caffeine intake recently has been shown to be an effective strategy to manage hypoglycemia after bariatric surgery . In fact, most patients with hypoglycemia after bariatric surgery will respond to dietary modification or pharmacologic intervention . As an example, continuous glucose monitoring was useful in a pregnant patient with dumping syndrome after RYGB and poor adherence with conventional glucose monitoring .…”

Hypoglycemia After Gastric Bypass Surgery: Current Concepts and Controversies

“…The natural history of post-RYGB remains uncertain. One series that identified hypoglycemia based on clinical and billing data (80) found that the median time from surgery to the hypoglycemic event was 41 months; 79% of cases identified eventually resolved. In our experience, dumping syndrome-related symptoms generally improve over time by avoiding triggers, whereas severe hypoglycemia does not.…”

Sociedade Portuguesa para o Estudo da Obesidade Recommendations on the Management and Treatment of Hypoglycaemia After Bariatric Surgery

“…18 Mais de 95% dos relatos de hipoglicemia pós-cirurgia bariátrica ocorre em doentes submetidos a bypass gástrico e apenas uma minoria (2%) ocorre após sleeve gástrico. 19 Excecionalmente, já foi descrito após colocação de banda gástrica. Também ocorre em doentes submetidos a switch duodenal porém, esta técnica cirúrgica não é atualmente a preferencial no tratamento da obesidade.…”

“…23,46,48,49 Esta é uma solução temporária, por vezes utilizada antes de uma cirurgia mais agressiva. 19 2. Restrição da bolsa gástrica com anel ou banda ajustável.…”