Post-prandial Hypoglycemia after Bariatric Surgery: Pharmacological Treatment with Verapamil and Acarbose

Moreira, Rodrigo O.; Moreira, Rustan B. M.; Machado, Nikolas A. M.; Gonçalves, Tatiana B.; Coutinho, Walmir

doi:10.1007/s11695-008-9569-9

Cited by 125 publications

(92 citation statements)

References 20 publications

(26 reference statements)

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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

Fried

Yumuk

Jm³

et al. 2017

Gastroent Hepatol

147

207

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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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Section: Follow-upmentioning

confidence: 99%

Interdisciplinary European guidelines on metabolic and bariatric surgery

Fried

Yumuk

Jm³

et al. 2017

Gastroent Hepatol

147

207

View full text Add to dashboard Cite

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“…Several treatments have been proposed in the literature; these involve acarbose (24,25), calcium channel antagonists (nifedipine and verapamil) (26), the somatostatin analogues octreotide (27) and pasireotide (28), the b-cell inhibitor diazoxide (29), and finally and ultimately, partial pancreatectomy (30). Glucagon has been tried as infusion but has not been proven to be useful perhaps because of its concomitantly high levels of insulin (31).…”

Section: Introductionmentioning

confidence: 99%

Hypoglycemia in everyday life after gastric bypass and duodenal switch

Abrahamsson

Engström

Sundbom

et al. 2015

European Journal of Endocrinology

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Design: Gastric bypass (GBP) and duodenal switch (DS) in morbid obesity are accompanied by marked metabolic improvements, particularly in glucose control. In recent years, episodes of severe late postprandial hypoglycemia have been increasingly described in GBP patients; data in DS patients are scarce. We recruited three groups of subjects; 15 GBP, 15 DS, and 15 non-operated overweight controls to examine to what extent hypoglycemia occurs in daily life. Methods: Continuous glucose monitoring (CGM) was used during 3 days of normal activity. The glycemic variability was measured by mean amplitude of glycemic excursion and continuous overall net glycemic action. Fasting blood samples were drawn, and the patients kept a food and symptom log throughout the study. Results: The GBP group displayed highly variable CGM curves, and 2.9% of their time was spent in hypoglycemia (!3.3 mmol/l, or 60 mg/dl). The DS group had twice as much time in hypoglycemia (5.9%) and displayed CGM curves with little variation as well as lower HbA1c levels (29.3 vs 35.9 mmol/mol, P!0.05). Out of a total of 72 hypoglycemic episodes registered over the 3-day period, 70 (97%) occurred in the postprandial state and only about one-fifth of the hypoglycemic episodes in the GBP and DS groups were accompanied by symptoms. No hypoglycemias were seen in controls during the 3-day period. Conclusion: Both types of bariatric surgery induce marked, but different, changes in glucose balance accompanied by frequent, but mainly unnoticed, hypoglycemic episodes. The impact and mechanism of hypoglycemic unawareness after weight-reduction surgery deserves to be clarified.

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“…Sporadic reflectance meter glucose determinations in the home setting should be requested to certificate and these subjects should be submitted to an evaluation to differentiate non insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) from factitious or iatrogenic causes, dumping syndrome, and insulinoma. In these patients, second-line medical therapeutic strategies can be considered, including acarbose, calcium channel antagonists (verapamyl), octreotide and diazoxide (11,13,39,40).…”

Section: A Update On Bariatric Surgerymentioning

confidence: 99%

Bariatric surgery – An update for the endocrinologist

Mancini

2014

Arq Bras Endocrinol Metab

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Obesity is a major public health problem, is associated with increased rates of mortality risk and of developing several comorbidities, and lessens life expectancy. Bariatric surgery is the most effective treatment for morbidly obese patients, reducing risk of developing new comorbidities, health care utilization and mortality. The establishment of centers of excellence with interdisciplinary staff in bariatric surgery has been reducing operative mortality in the course of time, improving surgical safety and quality. The endocrinologist is part of the interdisciplinary team. The aim of this review is to provide endocrinologists, physicians and health care providers crucial elements of good clinical practice in the management of morbidly obese bariatric surgical candidates. This information includes formal indications and contraindications for bariatric operations, description of usual bariatric and metabolic operations as well as endoscopic treatments, preoperative assessments including psychological, metabolic and cardiorespiratory evaluation and postoperative dietary staged meal progression and nutritional supplementation follow-up with micronutrient deficiencies monitoring, surgical complications, suspension of medications in type 2 diabetic patients, dumping syndrome and hypoglycemia. Arq Bras Endocrinol Metab. 2014;58(9):875-88 Keywords Bariatric surgery; Roux-en-Y gastric bypass; biliopancreatic diversions; obesity; weight loss RESUMO A obesidade é um problema de saúde pública, está associada com aumento do risco de mortalidade e de desenvolver diversas comorbidades e diminui a expectativa de vida. A cirurgia bariátrica é o tratamento mais eficaz para pacientes com obesidade mórbida, reduzindo o desenvolvimento de novas comorbidades, a utilização dos cuidados de saúde e a mortalidade. A criação de centros de excelência com equipes interdisciplinares em cirurgia bariátrica vem reduzindo a mortalidade operatória no decorrer do tempo, melhorando a segurança e a qualidade cirúrgica. O endocrinologista faz parte da equipe interdisciplinar. O objetivo desta revisão é fornecer aos endocrinologistas, médicos e prestadores de cuidados de saúde elementos cruciais de boas práticas clínicas no tratamento de pacientes com obesidade mórbida candidatos à cirurgia bariátrica. Essas informações incluem indicações formais e contraindicações para as operações bariátricas, descrição das operações bariátricas e metabólicas habituais, bem como tratamentos endoscópicos, avaliação pré-operatória, incluindo avaliação cardiorrespiratória psicológica, metabólica e no pós-operatório, dieta com refeições progressivamente estagiadas e seguimento com suplementação nutricional e monitoramento de deficiências de micronutrientes, complicações cirúrgicas, suspensão de medicamentos em pacientes diabéticos tipo 2, síndrome de dumping e hipoglicemia. Arq Bras Endocrinol Metab. 2014;58(9):875-88 Descritores Cirurgia bariátrica; bypass gástrico em Y de Roux; desvios biliopancreáticos; obesidade; perda de peso

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Post-prandial Hypoglycemia after Bariatric Surgery: Pharmacological Treatment with Verapamil and Acarbose

Cited by 125 publications

References 20 publications

Interdisciplinary European guidelines on metabolic and bariatric surgery

Interdisciplinary European guidelines on metabolic and bariatric surgery

Hypoglycemia in everyday life after gastric bypass and duodenal switch

Bariatric surgery – An update for the endocrinologist

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