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Can You Get Diabetes After Gastric Bypass

How Common Is Hypoglycemia After Gastric Bypass?

How Common Is Hypoglycemia After Gastric Bypass?

How Common is Hypoglycemia After Gastric Bypass? Joslin Diabetes Center and Harvard Medical School, One Joslin Place, Boston, MA 02215, Tel 617-309-2643, Fax 617-309-3403 Allison B. Goldfine: [email protected] ; Mary Elizabeth Patti: [email protected] The publisher's final edited version of this article is available free at Obesity (Silver Spring) See the article " Prevalence of Hypoglycemic Symptoms after Roux-en-Y Gastric Bypass and Vertical Sleeve Gastrectomy and Associated Risk Factors " in Obesity (Silver Spring), volume 23 onpage1079. See other articles in PMC that cite the published article. Bariatric surgery leads to substantial and sustained weight loss, and resolution or improvements in type 2 diabetes, hypertension and dyslipidemia. Cohort studies support improved longer-term mortality. Metabolic health improvements and safety vary with the specific bariatric surgery performed, likely a result of procedure-specific anatomic and physiologic changes. Recently, increased attention has focused on a syndrome of hypoglycemia with neuroglycopenia observed most commonly following Roux-en-Y gastric bypass (RYGB), which typically first presents more than 12 years postoperatively and occurs predominantly in the postprandial state ( 1 , 2 ). Post-bariatric hypoglycemia can be life-threatening with altered consciousness, seizures, and motor vehicle accidents. Understanding the frequency of this syndrome and identifying which patients may be at risk is highly relevant given the large number of bariatric procedures performed worldwide. Lee et al. (ref) now provide additional insights into the occurrence of post-RYGB hypoglycemia. The authors performed a retrospective survey of the bariatric registry and electronic medical records of G Continue reading >>

Hypoglycemia After Gastric Bypass: An Emerging Complication

Hypoglycemia After Gastric Bypass: An Emerging Complication

Bariatric surgery, though beneficial, is associated with complications, one of which is post-gastric bypass hypoglycemia (PGBH).1 The mean time from gastric bypass to documented hypoglycemia is about 28 months.2 PGBH is probably more common than initially thought. In older reports, the prevalence was only 0.1% to 0.36%.1,3 In contrast, in a mail survey in 2015,4 one-third of bariatric surgery patients reported symptoms that raised the suspicion of hypoglycemia. Those with suspicious symptoms were more likely to have undergone Roux-en-Y surgery, to have had no preoperative diabetes, to have had a longer interval since surgery, and to be female. Restricting the suspicion of postprandial hypoglycemia to those who reported more serious symptoms, including needing third-party assistance, the prevalence was 11.6%. Kefurt et al5 followed Roux-en-Y patients who wore a continuous glucose monitor for 86 months after surgery and found that 38% had hypoglycemia; however, symptoms of hypoglycemia were not discussed. Thus, the exact prevalence is currently unknown. But as time goes by and more procedures are performed, the incidence will likely rise. OBESITY IS ON THE RISE, AND SO IS WEIGHT-LOSS SURGERY Obesity is rampant, and its prevalence continues to rise. In 2011–2012, more than two-thirds of adults in the United States were reported as obese.6 Complications of obesity such as cardiac disease, diabetes, and cancer lead to increased mortality risk.7 Obesity is difficult to reverse, as many people fail to lose weight with diet, exercise, and pharmacotherapy. Given the difficulty of losing weight and the complications that arise from obesity, bariatric surgery has become increasingly popular. Not only do patients lose significantly more weight with bariatric surgery than with con Continue reading >>

Reactive Hypoglycemia Post–gastric Bypass

Reactive Hypoglycemia Post–gastric Bypass

Reactive hypoglycemia (RH) may occur in patients one year or more after their bariatric surgery. Symptoms include shakiness, hunger, dizziness, cold sweats, confusion, anxiety and possible loss of consciousness. The further out from surgery you are, the more tuned in to your body and reactions to food you become. Definition: RH is low blood sugar typically 1.5 to 3 hours following a meal. You probably will begin to recognize the signs and symptoms of low blood sugar. This is not related to a diabetes insulin reaction or even a former diagnosis of diabetes prior to surgery. RH is simply a side effect of gastric bypass that happens in a minority of patients. Pre-surgery excess weight leads to excess insulin production and insulin resistance. Additionally, the bypass surgery leads to certain hormone level increases that also increase insulin production. After surgery, patients become more sensitive to insulin, more rapidly clearing sugars from the blood stream and this is why low blood sugars, or RH, can occur. Treatment: The way to treat symptoms is based on how severe they are. If it is time for the next meal, simply eat your normal meal. If you begin to feel like you are having a somewhat low blood sugar—a little weakness and shakiness—and it is not time for a meal, simply have a small carbohydrate (5g) choice with a small protein food, for example, five crackers with a string cheese, 1 lite Greek yogurt or a half piece of toast with peanut butter. On the other hand, if you have more serious symptoms such as nearly fainting and sweating profusely then it is time for a quick sugar hit. Have 4–6 ounces of regular juice or two glucose tablets as a rescue dose of glucose. Be cautious as this may lead to another low later on as your body processes this dose of sugar. I Continue reading >>

Diabetes Reversal After Bypass Surgery Linked To Changes In Gut Microorganisms

Diabetes Reversal After Bypass Surgery Linked To Changes In Gut Microorganisms

Studies have shown that bariatric surgery can lead to remission of type 2 diabetes mellitus (T2DM) in rodents and humans, but this beneficial effect cannot be explained solely by weight loss. In a new study, researchers investigating gastric bypass in a mouse model of T2DM confirmed that bypass surgery improves glucose tolerance and insulin sensitivity. Interestingly, the improved metabolism occurred in conjunction with changes in gut microorganisms, suggesting a potential role for gut microbiota in diabetes remission. Studies have shown that bariatric surgery can lead to remission of type 2 diabetes mellitus (T2DM) in rodents and humans, but this beneficial effect cannot be explained solely by weight loss. In a new study published in The American Journal of Pathology, researchers investigating gastric bypass in a mouse model of T2DM confirmed that bypass surgery improves glucose tolerance and insulin sensitivity. Interestingly, the improved metabolism occurred in conjunction with changes in gut microorganisms, suggesting a potential role for gut microbiota in diabetes remission. "Our research showed that duodenum-jejunum gastric bypass (DJB) surgery may be applied to cure diabetes of both genetic (mutation) and environmental (diet-induced) origin," explained lead investigator Xiang Gao, PhD, of State Key Laboratory of Pharmaceutical Biotechnology and MOE Key Laboratory of Model Animal for Disease Study, Model Animal Research Center, Nanjing Biomedical Research Institute and the Collaborative Innovation Center of Genetics and Development, Nanjing University. "We found that DJB surgery induced gut microbiota alterations, which may be the key reason for diabetes remission after bariatric surgery. Our data indicate that suppressed inflammation is the result, not the cause Continue reading >>

Gastric Bypass Surgery Helps Diabetes But Does Not Cure It

Gastric Bypass Surgery Helps Diabetes But Does Not Cure It

Gastric bypass surgery for patients with type two diabetes, in most cases, is either remitted or relapses within five years, researchers from the Group Health Research Institute reported in the journal Obesity Surgery. The authors explained that after gastric bypass surgery, diabetes symptoms may disappear for some patients - in many cases before they lose a lot of weight. Does this mean, therefore, that gastric bypass surgery is a "cure" for diabetes? Not necessarily, they wrote, after gathering and analyzing data from the largest community-based study that looked at the long-term outcomes after bariatric surgery among diabetes patients. For two thirds of the participants in the study, their diabetes initially disappeared after gastric surgery - however, symptoms returned within five years among one third of them. They added the proportion of patients whose diabetes never went away after surgery, and found that 56% had no long-lasting diabetes remission. When diabetes did go away, it stayed away for several years - an important benefit. Experts know that bariatric surgery (weight loss surgery) is much more effective in reducing heart disease and stroke risk than medications, researchers from the Cleveland Clinic recently explained. They reported their findings in the journal Heart (October 2012 issue). Their study involved very obese patients, including those with and without diabetes. Who receives the most benefit from gastric surgery? Lead researcher, David E. Arterburn, MD, MPH, explained that those with less severe diabetes symptoms tended to benefit the most from gastric surgery - they were the ones most likely to experience remission after the operation, and for longer. Dr. Arterburn said: "Gastric surgery isn't for everyone. But this evidence suggests that, once Continue reading >>

Incidence Of Type 2 Diabetes After Bariatric Surgery: Population-based Matched Cohort Study - Sciencedirect

Incidence Of Type 2 Diabetes After Bariatric Surgery: Population-based Matched Cohort Study - Sciencedirect

Volume 2, Issue 12 , December 2014, Pages 963-968 Incidence of type 2 diabetes after bariatric surgery: population-based matched cohort study Open Access funded by Department of Health UK The effect of currently used bariatric surgical procedures on the development of diabetes in obese people is not well defined. We aimed to assess the effect of bariatric surgery on development of type 2 diabetes in a large population of obese individuals. We did a matched cohort study of adults (age 20100 years) identified from a UK-wide database of family practices, who were obese (BMI 30 kg/m2) and did not have diabetes. We enrolled 2167 patients who had undergone bariatric surgery between Jan 1, 2002, and April 30, 2014, and matched themaccording to BMI, age, sex, index year, and HbA1cwith 2167 controls who had not had surgery. Procedures included laparoscopic gastric banding (n=1053), gastric bypass (795), and sleeve gastrectomy (317), with two procedures undefined. The primary outcome was development of clinical diabetes, which we extracted from electronic health records. Analyses were adjusted for matching variables, comorbidity, cardiovascular risk factors, and use of antihypertensive and lipid-lowering drugs. During a maximum of 7 years of follow-up (median 28 years [IQR 1345]), 38 new diagnoses of diabetes were made in bariatric surgery patients and 177 were made in controls. By the end of 7 years of follow-up, 43% (95% CI 2965) of bariatric surgery patients and 162% (133196) of matched controls had developed diabetes. The incidence of diabetes diagnosis was 282 (95% CI 244327) per 1000 person-years in controls and 57 (4278) per 1000 person-years in bariatric surgery patients; the adjusted hazard ratio was 020 (95% CI 013030, p<00001). This estimate was robust after varying t Continue reading >>

Be Aware Of Blood Sugar Post Gastric Bypass

Be Aware Of Blood Sugar Post Gastric Bypass

(PhysOrg.com) -- People with type 2 diabetes who have gastric bypass surgery often leave the hospital without the need for previously prescribed diabetes medications. Researchers and doctors believe this health benefit is related to changes in the body’s circulating hormones—particularly an increase of insulin secretion. Insulin is the hormone that controls the level of glucose (sugar) in the blood. Marzieh Salehi, MD, a diabetologist with UC Health University of Cincinnati Physicians whose research is focused on the effect of weight-loss surgery on glucose metabolism, cautions that although there can be huge benefits for diabetic patients who undergo gastric bypass surgery, a group of patients experience severely low levels of blood sugar (hypoglycemia)—especially following a meal and typically several years after surgery. Symptoms of hypoglycemia often aren’t recognized until they become debilitating or life-threatening. Salehi says that many patients with type 2 diabetes who qualify for gastric bypass surgery rely on anti-diabetic medications like insulin injections to regulate glucose in the body. These same patients often leave the hospital following surgery with normal glucose control without taking any medications. “It’s possible,” says Salehi, “that gastric bypass increases gut hormone secretion or nervous system activity, which in turn increases insulin secretion and improves glucose metabolism in a majority of patients after surgery. “However,” she adds, “there is a population of gastric bypass patients who, following surgery, develop high levels of endogenous insulin secretion, resulting in dangerously low glucose levels, or hypoglycemia. These glucose abnormalities due to too much insulin secretion represent an extreme effect of gastric Continue reading >>

Unveiling The “magic” Of Diabetes Remission After Weight-loss Surgery

Unveiling The “magic” Of Diabetes Remission After Weight-loss Surgery

An extraordinary thing happens to some patients with type 2 diabetes who undergo weight-loss surgery: Within days of the procedure, they improve their insulin production and need fewer or no diabetes medications. Although it’s well established that losing weight, especially around the waistline, improves pancreas function and insulin sensitivity, it generally takes 6 months to a year after bariatric surgery before a patient sheds a substantial number of pounds. Bruce M. Wolfe, MD, professor of surgery at Oregon Health and Science University School of Medicine, recalled one “remarkable” case in which a patient who required 400 daily units of insulin prior to gastric bypass surgery needed none on the day she was discharged from the hospital. Continue reading >>

Severe Hypoglycemia - Complication Of Gastric Bypass Surgery

Severe Hypoglycemia - Complication Of Gastric Bypass Surgery

Physicians monitoring patients who have undergone gastric bypass surgery should be on the alert for a new, potentially dangerous hypoglycemia (low blood glucose) complication that, while rare, may require quick treatment, according to a new study by collaborating researchers at Joslin Diabetes Center, Beth Israel Deaconess Medical Center (BIDMC), and Brigham and Women's Hospital (BWH) and published in the October issue of the journal Diabetologia. The paper follows on the heels of a Mayo Clinic report on six similar case studies published in July in the New England Journal of Medicine. About 160,000 people undergo gastric bypass surgery every year. The study details the history of three patients, who did not have diabetes, who suffered such severe hypoglycemia following meals that they became confused and sometimes blacked out, in two cases causing automobile collisions. The immediate cause of hypoglycemia was exceptionally high levels of insulin following meals. All three patients in the collaborative study failed to respond to medication, and ultimately required partial or complete removal of the pancreas, the major source of insulin, to prevent dangerous declines in blood glucose. "Severe hypoglycemia is a complication of gastric bypass surgery, and should be considered if the patient has symptoms such as confusion, lightheadedness, rapid heart rate, shaking, sweating, excessive hunger, bad headaches in the morning or bad nightmares," says Mary-Elizabeth Patti, M.D., Investigator in Joslin's Research Section on Cellular and Molecular Physiology and Assistant Professor of Medicine at Harvard Medical School. "If these symptoms don't respond to simple changes in diet, such as restricting intake of simple carbohydrates, patients should be evaluated hormonally, quickly," Continue reading >>

Metabolic And Bariatric Surgery And Type 2 Diabetes

Metabolic And Bariatric Surgery And Type 2 Diabetes

Did You Know? Someone in the world dies from complications associated with diabetes every 10 seconds. Diabetes is one of the top ten leading causes of U.S. deaths. One out of ten health care dollars is attributed to diabetes. Diabetics have health expenditures that are 2.3 times higher than non-diabetics. Approximately 90 percent of type 2 diabetes mellitus (T2DM), the most common form of diabetes, is attributable to excessive body fat. If current trends continue, T2DM or pre diabetic conditions will strike as many as half of adult Americans by the end of the decade. (according to the United HealthGroup Inc., the largest U.S. health insurer by sales). The prevalence of diabetes is 8.9 percent for the U.S. population but more than 25 percent among individuals with morbid obesity. Metabolic and bariatric surgery is the most effective treatment for T2DM among individuals who are affected by obesity and may result in remission or improvement in nearly all cases. Type 2 Diabetes Mellitus (T2DM) Type 2 diabetes(T2DM) is the most common form of diabetes, accounting for approximately 95 percent of all cases. Obesity is the primary cause for T2DM and the alarming rise in diabetes prevalence throughout the world has been in direct association increase rates of obesity worldwide. T2DM leads to many health problems including cardiovascular disease, stroke, blindness, kidney failure, neuropathy, amputations, impotency, depression, cognitive decline and mortality risk from certain forms of cancer. Premature death from T2DM is increased by as much as 80 percent and life expectancy is reduced by 12 to 14 years. Current therapy for type 2 diabetes includes lifestyle intervention (weight-loss, appropriate diet, exercise) and anti-diabetes medication(s). Medical supervision and strict adh Continue reading >>

How Does Gastric Bypass Surgery Cure Type 2 Diabetes?

How Does Gastric Bypass Surgery Cure Type 2 Diabetes?

Gastric bypass surgery often improves the symptoms of type 2 diabetes, even before patients start to lose weight. Why? “What we found is that the secret for the cure of diabetes after gastric bypass lies in the intestine,” said Dr. Nicholas Stylopoulos, principal investigator at the Division of Endocrinology at Children's Hospital Boston and Boston Medical School, in an interview with Healthline. “The key message is that after gastric bypass the intestine becomes the most important tissue for glucose use and this decreases blood sugar levels.” His research was published last week in the journal Science. Doctors are hopeful they can find a way to mimic the processes that lead to improvements for type 2 diabetics after gastric bypass without actually doing the surgery. Small Intestine to the Rescue Here's how it works: After gastric bypass, which is a common weight loss solution for the severely obese, the small intestine spontaneously begins to produce a molecule called GLUT-1 that helps the body use glucose. “The quite amazing thing is that this is not present normally in the small intestine of adults, but only in the fetus,” said Dr. Erini Nestoridi, a research fellow in Stylopoulos' lab, in an interview with Healthline. “This happens most likely because the intestine has to work harder to do its job, for example to absorb the nutrients or move the food further down. Also, it may be that the mechanical stress of 'dumping' the food directly to the intestine, since the stomach is bypassed, contributes to these changes.” Although weight loss and improved diabetes symptoms go hand in hand, previous research has shown that gastric bypass surgery helps resolve the disease even before weight loss occurs. According to the U.S. Centers for Disease Control and Pr Continue reading >>

The Strange Side Effect Of Gastric Bypass That Helps Diabetics

The Strange Side Effect Of Gastric Bypass That Helps Diabetics

Gastric bypass seems to help diabetic patients by changing the way their body regulates gut hormones . This may be because theres no more stomach cavity, or perhaps because a small section of the intestines where these hormones might be stimulated is removed no one is quite sure . But we do know that around two thirds of patients who get gastric bypass dont require any medication to treat their diabetes, and they stay that way for years ( follow-up studies have only gone out five years so far). The weight loss itself also helps, since shedding body fat improves diabetes generally, but patients on traditional medication and weight loss interventions dont see nearly the same improvement. In fact, many of them are in exactly the same position at the five-year mark as they were on day one, while their surgically-enhanced counterparts have often put their diabetes into remission. Some other bariatric surgeries are just as good for diabetics As we said earlier, gastric bypass is only the best-known of the bariatric surgeries. Theres also an adjustable gastric band, which is exactly what it sounds like: a band that creates a smaller stomach pouch over time as its tightened. Its not the most effective method for either weight loss or diabetes improvement, but it is (relatively) easy and fast, and has the lowest rate of surgical complications. Another method is the sleeve gastrectomy, which doesnt so much put a sleeve on the stomach as it does make the stomach look like a sleeve. By removing part of the organ, surgeons can make it smaller and more tubular. This method seems to be just as effective as full gastric bypass in terms of both weight loss and diabetes remissionpeople lose about 50 percent of their body mass and a majority of patients see improvement in their gut hormo Continue reading >>

Hypoglycemia After Gastric Bypass Surgery

Hypoglycemia After Gastric Bypass Surgery

In Brief Severe hypoglycemia characterized by neuroglycopenic symptoms is a recently described and relatively uncommon complication of gastric bypass surgery. It occurs several months to years after surgery and may be distinct from the more commonly encountered dumping syndrome that occurs early in the postoperative course and usually improves with time. Nesidioblastosis has been proposed as a possible underlying mechanism for late postoperative hypoglycemia. This syndrome is distinct from noninsulinoma pancreatogenous hypoglycemia and likely has a multifactorial etiology. It responds variably to nutrition and pharmacological interventions. Partial pancreatectomy and reversal of the bypass have sometimes been used to ameliorate symptoms. Obesity rates are increasing annually, making obesity and its related conditions a major public health problem. Lifestyle measures have had limited success in the management of morbid obesity, and bariatric surgery remains the only intervention that results in significant, sustained weight loss and improvement or resolution of comorbidities such as type 2 diabetes.1,2 Furthermore, bariatric procedures have been shown to decrease overall mortality in the obese population in longitudinal, observational studies.3,4 The rising popularity of bariatric procedures is therefore not surprising. Roux-en-Y gastric bypass (RYGB) surgery is the most popular procedure used to treat medically complicated obesity,5 and the last decade has witnessed a tremendous increase in the number of these procedures performed.6 This has increased the frequency of complications associated with this procedure. Hyperinsulinemic hypoglycemia has been recognized relatively recently as a complication of gastric bypass surgery.7,8 Several years after this phenomenon was f Continue reading >>

Post-gastric Bypass Hypoglycemia: A Serious Complication Of Bariatric Surgery

Post-gastric Bypass Hypoglycemia: A Serious Complication Of Bariatric Surgery

Obesity is a rapidly increasing problem in the United States and worldwide, with more than 30% of adult Americans now affected. Unfortunately, we are lacking in effective therapies to promote significant weight loss. Although aggressive lifestyle modification is highly effective, it is plagued by difficulties with poor compliance, access and reimbursement. Medical therapy for obesity has limited efficacy and significant side effects, and with the recent withdrawal of sibutramine from the US market, there are limited options (See more info on this here). Therefore, more patients and providers are turning to bariatric surgery for the treatment of obesity and its comorbidities. Especially in the case of Roux-en-Y gastric bypass surgery, this is a highly effective therapy that can lead to significant weight loss and also improve metabolic parameters independent of weight loss. Roux-en-Y gastric bypass surgery involves attaching a small pouch of the upper stomach to the early part of the jejunum, thereby bypassing the majority of the stomach and the duodenum. This results in an increased sense of fullness and reduction in appetite, as well as alterations in hormonal release from the small intestine in response to food. This procedure has been found to lead to resolution of type 2 diabetes in up to 80% of patients. It has therefore been proposed as a potential “cure” for type 2 diabetes. Evaluating risks of surgery As with any therapy, Roux-en-Y gastric bypass surgery can result in adverse effects and complications. Although the immediate risks of morbidity and mortality from the surgery are low, the long-term risks associated with malabsorption and other complications are still being clarified as an increasing number of patients are undergoing this procedure. One long-te Continue reading >>

How Weight Loss Surgery Helps Type 2 Diabetes

How Weight Loss Surgery Helps Type 2 Diabetes

Weight loss surgery can make a big difference for people with type 2 diabetes. For some people, blood sugar levels get back to normal after surgery. Diabetes can be cured.That could mean you need less medication or none at all. Research shows improvements in type 2 diabetes after weight loss surgery. One long-term study tracked 400 people with type 2 diabetes. Six years after bariatric surgery, 62% showed no signs of diabetes. They also had better blood pressure, cholesterol, and triglyceride levels. In comparison, only 6% to 8% of people who took medicine, but didn’t have surgery, showed similar results. If you’re thinking about it, and you’re ready to make big changes to keep up the results, you’ll want to know if it’s right for you. First, your doctor will consider two things: Is your BMI 35 or higher? Have you tried to lose weight and keep it off without success? If so, he will give you a detailed checkup and ask you questions to see if you are physically and emotionally ready for the operation and the major changes you'll need to make. (You'll need to eat a lot less and make a healthy diet and exercise part of your life forever.) Depending on your particular case, other doctors may also get involved. For instance, if you have heart disease, your cardiologist would need to approve you for surgery. There are different kinds of operations. Some help you lose weight by shrinking the size of your stomach so you feel full after small meals. Others change the way your body absorbs calories, nutrients, and vitamins. Still others do both. Get to know what’s involved with each of these: 1. Gastric bypass (also called Roux-en-Y gastric bypass) The surgeon makes a small stomach pouch by dividing the top of the stomach from the rest of it. When you eat, food goes to Continue reading >>

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