Hypoglycemia

[Guest guest]

The research shows fiber, particularly pectin is useful

Amy Long Carrera MS, RD Clinical Dietitian Northridge Hospital Medical Center & Center for Weight Loss Surgery Northridge, CA Amy.Long@... 818-885-8500 x4034

From: [mailto: ] On Behalf Of kristen.smith46Sent: Thursday, January 08, 2009 5:29 AM Subject: hypoglycemia

Hi! We have recently been having some patients become hypoglycemic after Gastric bypass surgery. I was just wondering if anyone had any suggestions on how to treat this? Thanks. , RD,CDNMontefiore Medical Center Bariatric Surgery Dietitian

[Guest guest]

Have she tried treating the hypoglycemia with the rule of 15 and post response treatmentSent from my Verizon Wireless BlackBerryFrom: ", Cara" <cara.stewart@...>Date: Thu, 12 Nov 2009 13:50:59 -0500< >Subject: Hypoglycemia Hello, We have a pt who is 2years post gastric bypass that has been experiencing hypoglycemic episodes on adaily basis since August. She reports making healthy food choices andeating protein every 2-3 hours. Symptoms occur at random per pt, bothbefore and after eating and occasionally waking her up in the middle of thenight. Lowest blood glucose has been 52 and she starts experiencingsymptoms in the 90’s. She is currently seeing an endocrinologistwho referred her to a dietitian to review her diet. I cannot identify anypatterns with her diet that may be causing these episodes. After anarticle search, I found a number of articles about hyperinsulinemia and severepostprandial hypoglycemia after RYGB. Some research shows substantivesymptom improvement with a low-carbohydrate diet. Any experience withthis problem? Advice to treat? Thank you, Cara Cara , RD, LDNClinical DietitianThe Hospital of the University of PennsylvaniaPhone: 215-662-2085Fax: 215-662-3148E-mail: Cara.uphs (DOT) upenn.edu The information contained in this e-mail message is intended only for the personal and confidential use of the recipient(s) named above. If the reader of this message is not the intended recipient or an agent responsible for delivering it to the intended recipient, you are hereby notified that you have received this document in error and that any review, dissemination, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, please notify us immediately by e-mail, and delete the original message.

[Guest guest]

I have had a few pts with this, it is called nesidioblastosis. A referral to endocrine is in order, I have seen them successfully treat with prandin.....some need to be evaluated for partial pancreatectomy. They are studying this at Mayo

Diane Olson MS RD CDE UW Health Bariatric Surgery Program University of Wisconsin Hospital and Clinics (608) 265-1718 dolson3@...

-----Original Message-----From: [mailto: ] On Behalf Of , CaraSent: Thursday, November 12, 2009 12:51 PM Subject: Hypoglycemia

Hello,

We have a pt who is 2 years post gastric bypass that has been experiencing hypoglycemic episodes on a daily basis since August. She reports making healthy food choices and eating protein every 2-3 hours. Symptoms occur at random per pt, both before and after eating and occasionally waking her up in the middle of the night. Lowest blood glucose has been 52 and she starts experiencing symptoms in the 90’s. She is currently seeing an endocrinologist who referred her to a dietitian to review her diet. I cannot identify any patterns with her diet that may be causing these episodes. After an article search, I found a number of articles about hyperinsulinemia and severe postprandial hypoglycemia after RYGB. Some research shows substantive symptom improvement with a low-carbohydrate diet.

Any experience with this problem? Advice to treat?

Thank you,

Cara

Cara , RD, LDN

Clinical Dietitian

The Hospital of the University of Pennsylvania

Phone: 215-662-2085

Fax: 215-662-3148

E-mail: Cara.@...

The information contained in this e-mail message is intended only for the personal and confidential use of the recipient(s) named above. If the reader of this message is not the intended recipient or an agent responsible for delivering it to the intended recipient, you are hereby notified that you have received this document in error and that any review, dissemination, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, please notify us immediately by e-mail, and delete the original message.

[Guest guest]

We had a similar situation with a patient about 3 years post GBS. I had her eat about 15 grams of carbohydrate from starches with every

meal and snack (essentially 5-6 times per day). Her meals sometimes consisted of 30 grams of carbs when she also consumed fruit, yogurt, or beans. Her symptoms resolved after this.

From:

[mailto: ] On Behalf Of

kgnevil6801@...

Sent: Thursday, November 12, 2009 11:00 AM

Subject: Re: Hypoglycemia

Have she tried treating the hypoglycemia with the rule of 15 and post response treatment

Sent from my Verizon Wireless BlackBerry

From:

" , Cara " <cara.stewartuphs (DOT) upenn.edu>

Date:

Thu, 12 Nov 2009 13:50:59 -0500

To:

< >

Subject:

Hypoglycemia

Hello,

We have a pt who is 2 years post gastric bypass that has been experiencing

hypoglycemic episodes on a daily basis since August. She reports making healthy food choices and eating protein every 2-3 hours. Symptoms occur at random per pt, both before and after eating and occasionally waking her up in the middle of the night. Lowest

blood glucose has been 52 and she starts experiencing symptoms in the 90’s. She is currently seeing an endocrinologist who referred her to a dietitian to review her diet. I cannot identify any patterns with her diet that may be causing these episodes. After

an article search, I found a number of articles about hyperinsulinemia and severe postprandial hypoglycemia after RYGB. Some research shows substantive symptom improvement with a low-carbohydrate diet.

Any experience with this problem? Advice to treat?

Thank you,

Cara

Cara , RD, LDN

Clinical Dietitian

The Hospital of the

University of

Pennsylvania

Phone: 215-662-2085

Fax: 215-662-3148

E-mail: Cara.uphs (DOT) upenn.edu

The information contained in this e-mail message is intended only for the personal and confidential use of the recipient(s) named above. If the reader of this message is not the intended recipient or an agent responsible for delivering it to the intended recipient,

you are hereby notified that you have received this document in error and that any review, dissemination, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, please notify us immediately by e-mail,

and delete the original message.

Notice from St. ph Health System:

Please note that the information contained in this message may be privileged and confidential and protected from disclosure.

[Guest guest]

What is her daily carb intake? Is it enough to provide adequate BG and glycogen stores? We need to be aware of more than just protein and calories; it is important to have a broder perspective that looks at the balance of nutrients (and gm of CHO). Before jumping to conclusions that this is an endocrine disorder, please evaluate for adequate carb intake.

Sally Hara, MS, RD, CDE, CSSD Registered Dietitian, Certified Diabetes Educator Board Certified Specialist in Sports DieteticsProActive Nutrition, LLC Kirkland, WA (425) 814-8443 No diet will remove all the fat from your body because the brain is entirely fat. Without a brain, you might look good, but all you could do is run for public office. - Bernard Shaw

From: .Buntzen@...Date: Thu, 12 Nov 2009 12:29:28 -0800Subject: RE: Hypoglycemia

We had a similar situation with a patient about 3 years post GBS. I had her eat about 15 grams of carbohydrate from starches with every meal and snack (essentially 5-6 times per day). Her meals sometimes consisted of 30 grams of carbs when she also consumed fruit, yogurt, or beans. Her symptoms resolved after this.

From: [mailto: ] On Behalf Of kgnevil6801 Sent: Thursday, November 12, 2009 11:00 AM Subject: Re: Hypoglycemia

Have she tried treating the hypoglycemia with the rule of 15 and post response treatment

Sent from my Verizon Wireless BlackBerry

From: ", Cara" <cara.stewartuphs (DOT) upenn.edu>

Date: Thu, 12 Nov 2009 13:50:59 -0500

< >

Subject: Hypoglycemia

Hello,

We have a pt who is 2 years post gastric bypass that has been experiencing hypoglycemic episodes on a daily basis since August. She reports making healthy food choices and eating protein every 2-3 hours. Symptoms occur at random per pt, both before and after eating and occasionally waking her up in the middle of the night. Lowest blood glucose has been 52 and she starts experiencing symptoms in the 90’s. She is currently seeing an endocrinologist who referred her to a dietitian to review her diet. I cannot identify any patterns with her diet that may be causing these episodes. After an article search, I found a number of articles about hyperinsulinemia and severe postprandial hypoglycemia after RYGB. Some research shows substantive symptom improvement with a low-carbohydrate diet.

Any experience with this problem? Advice to treat?

Thank you,

Cara

Cara , RD, LDN

Clinical Dietitian

The Hospital of the University of Pennsylvania

Phone: 215-662-2085

Fax: 215-662-3148

E-mail: Cara.uphs (DOT) upenn.edu

The information contained in this e-mail message is intended only for the personal and confidential use of the recipient(s) named above. If the reader of this message is not the intended recipient or an agent responsible for delivering it to the intended recipient, you are hereby notified that you have received this document in error and that any review, dissemination, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, please notify us immediately by e-mail, and delete the original message.

Notice from St. ph Health System:Please note that the information contained in this message may be privileged and confidential and protected from disclosure.

[Guest guest]

-

If her diet is appropriate and it is not a 'return' of diabetes, she might be

experiencing hyerinsulinemia v neuroglycopenia. This is seen in post-RNYGB

patients regardless if they had DM prior to surgery or not. There are a couple

of theories out there, but really nothing substantial. Short of a

pancreatectomy (which is really not a practical option) intervention we have

found to be somewhat helpful is to recommend a structured diet, monitoring

carbohydrate intake.

The Journal of Clinical Endocrinology & Metabolism (J CLin Endocrinol Metab 92:

4678-4685, 2007) had an interesting article: " Patients with Neuroglycopenia

after Gastric Bypass Surgery Have Elevated Incretin and Insulin secretory

Responses to a Mixed Meal "

Check out the article, it will help you better understand what might be going

on. Also may help you educate the patient and develop a plan.

>

>

>

> I have been following a GBP patient who is about two years postop.  Doing well

maintaining her weight loss.  Her only issue recently has been drops in her

sugars.  She does have a history of DM prior to surgery.  I've asked her to keep

records of when she is checking, and her eating habits, but it does not seem to

correlate.  She exercises regularly, but also does not seem to be in any

consistant pattern with her activity.  Any suggestions????

>  

>

> Joo, RD

> Kennedy Health System

>

[Guest guest]

We have found that eating protein with carb in the small frequent meals helps

blunt over insulin response in much the same was we treat reactive hypoglycemia

in non bariatric surgery pts. We have also had some pts we have sent to

endocrinology where they have used precose with good results.

In 2 severe cases not responding to above we have put in a G-tube in the remnant

stomach so that tube feeding stimulates bypassed gut response and this was very

effective. However pts may not want to live that way, one chose to continue

this, the other opted for surgical reversal of her bypass. Another pt did have

partial pancreatectomy with some benefit.

Diane Olson MS RD CDE

UW Health Bariatric Surgery Program

University of Wisconsin Hospital and Clinics

(608) 265-1718

dolson3@...

Re: hypoglycemia

-

If her diet is appropriate and it is not a 'return' of diabetes, she might be

experiencing hyerinsulinemia v neuroglycopenia. This is seen in post-RNYGB

patients regardless if they had DM prior to surgery or not. There are a couple

of theories out there, but really nothing substantial. Short of a

pancreatectomy (which is really not a practical option) intervention we have

found to be somewhat helpful is to recommend a structured diet, monitoring

carbohydrate intake.

The Journal of Clinical Endocrinology & Metabolism (J CLin Endocrinol Metab 92:

4678-4685, 2007) had an interesting article: " Patients with Neuroglycopenia

after Gastric Bypass Surgery Have Elevated Incretin and Insulin secretory

Responses to a Mixed Meal "

Check out the article, it will help you better understand what might be going

on. Also may help you educate the patient and develop a plan.

>

>

>

> I have been following a GBP patient who is about two years postop. 

> Doing well maintaining her weight loss.  Her only issue recently has been

drops in her sugars.  She does have a history of DM prior to surgery.  I've

asked her to keep records of when she is checking, and her eating habits, but it

does not seem to correlate.  She exercises regularly, but also does not seem to

be in any consistant pattern with her activity.  Any suggestions????

>  

>

> Joo, RD

> Kennedy Health System

>

------------------------------------

[Guest guest]

Small and frquent mealsInclude complex carbsCut down unnecessary liquid calories2 walnuts2 almonds3 prunes1/2 bowl saladOats compulsoryVegetables also green leafy vegetables . Sent on my BlackBerry® from VodafoneFrom: <lauramorr@...>Sender: Date: Mon, 23 May 2011 13:58:04 -0400< >Reply Subject: hypoglycemia I know this has been mentioned before, but I had a patient who came in with hypoglycemia. She had gastic bypass 20 months ago and has started having lows along with high blood sugar. Does anyone have some guidelines as to how much carbohydrate they should be restricted to a day or at each meal.  I know they should eat small frequent meals and make sure they have protein at each meal and of course avoid concentrated sweets/sugars.  Just wanted to find out what most programs are recommending when they encounter patients with hypoglycemia. thanks -- Z. , RD, LDN, CDE

[Guest guest]

I would also remind her that eating and drinking at the same time can push the food through the stomach pouch too quickly and cause symptoms similar to dumping regardless of how much sugar is in the food and how much protein she takes in. Just one thought based on what I have seen. Teague, RD, LDNBayhealth Food & Nutrition ServicesBayhealth BariatricsMilford Memorial HospitalKent General Hospital(302) 430-5528 (office)(302) 735-2793 (pager) "If you find a path with no obstacles, it probably doesn't lead anywhere." ~ A. ----- wrote: ----- < >From: "Bizzarro, A Civ USAF AFMC 88 DTS/SGQD" Sent by: Date: 05/11/2012 12:24PMSubject: hypoglycemia Hello! I am hoping someone can help me with a patient I saw today that has been having severe hypoglycemic episodes 1 hour usually after eating. She has been eating more regularly now and including protein with every meal and does not eat any sugary foods and reads labels for sugars. Her episodes have decreased with eating more frequently but are still about 1 time per week to the point of almost passing out. It sounds like late dumping syndrome to me and I believe they have ruled out nesidioblastosis and insulinoma. My question is what other nutrition advice can I give her other than eating regularly, including protein with meals and avoiding meals/snacks that contain too many simple sugars. If anyone has had more experience with these patients I would love to hear what you recommend! Thanks for your help. Missy Bizzarro RD, LD WPAFB Medical CenterDayton, OH

[Guest guest]

if a pt continues to have episodes with diet changes we send to endocrinologist, I have seen them use acarbose with these pts with some success

From: [mailto: ] On Behalf Of Bizzarro, A Civ USAF AFMC 88 DTS/SGQDSent: Friday, May 11, 2012 11:24 AM Subject: hypoglycemia

Hello! I am hoping someone can help me with a patient I saw today that has been having severe hypoglycemic episodes 1 hour usually after eating. She has been eating more regularly now and including protein with every meal and does not eat any sugary foods and reads labels for sugars. Her episodes have decreased with eating more frequently but are still about 1 time per week to the point of almost passing out. It sounds like late dumping syndrome to me and I believe they have ruled out nesidioblastosis and insulinoma. My question is what other nutrition advice can I give her other than eating regularly, including protein with meals and avoiding meals/snacks that contain too many simple sugars. If anyone has had more experience with these patients I would love to hear what you recommend!

Thanks for your help.

Missy Bizzarro RD, LD WPAFB Medical Center

Dayton, OH

[Guest guest]

Acrabose treatment can It be discussed in detail pls Sent on my BlackBerry® from VodafoneFrom: angela_teague@...Sender: Date: Fri, 11 May 2012 13:25:37 -0400< >Reply Subject: Re: hypoglycemia I would also remind her that eating and drinking at the same time can push the food through the stomach pouch too quickly and cause symptoms similar to dumping regardless of how much sugar is in the food and how much protein she takes in. Just one thought based on what I have seen. Teague, RD, LDNBayhealth Food & Nutrition ServicesBayhealth BariatricsMilford Memorial HospitalKent General Hospital(302) 430-5528 (office)(302) 735-2793 (pager) "If you find a path with no obstacles, it probably doesn't lead anywhere." ~ A. ----- wrote: ----- < >From: "Bizzarro, A Civ USAF AFMC 88 DTS/SGQD" Sent by: Date: 05/11/2012 12:24PMSubject: hypoglycemia Hello! I am hoping someone can help me with a patient I saw today that has been having severe hypoglycemic episodes 1 hour usually after eating. She has been eating more regularly now and including protein with every meal and does not eat any sugary foods and reads labels for sugars. Her episodes have decreased with eating more frequently but are still about 1 time per week to the point of almost passing out. It sounds like late dumping syndrome to me and I believe they have ruled out nesidioblastosis and insulinoma. My question is what other nutrition advice can I give her other than eating regularly, including protein with meals and avoiding meals/snacks that contain too many simple sugars. If anyone has had more experience with these patients I would love to hear what you recommend! Thanks for your help. Missy Bizzarro RD, LD WPAFB Medical CenterDayton, OH

[Guest guest]

Thanks for the help with the hypoglycemia question. Can anyone comment on

Selective Eating Disorder? It is for a non-bariatric patient but I can see

how we might encounter this in a bariatric pt. I have a pt that is 20 years

old and will only eat 8-10 foods and has a BMI of 16. She wants to gain wt

but does not know how because she is afraid to try new foods. Next week she

starts meeting with psychologist so hopefully can make some headway. We are

pairing a new food with a food she already likes and she is drinking Enusre

Plus 2-3 times per week. If anyone has any experience with this disorder I

would love to hear about it. Thanks in advance!

Missy Bizzarro RD, LD

WPAFB Medical Center

hypoglycemia

Hello! I am hoping someone can help me with a patient I saw today

that has been having severe hypoglycemic episodes 1 hour usually after

eating. She has been eating more regularly now and including protein with

every meal and does not eat any sugary foods and reads labels for sugars.

Her episodes have decreased with eating more frequently but are still about

1 time per week to the point of almost passing out. It sounds like late

dumping syndrome to me and I believe they have ruled out nesidioblastosis

and insulinoma.

My question is what other nutrition advice can I give her other than

eating regularly, including protein with meals and avoiding meals/snacks

that contain too many simple sugars. If anyone has had more experience with

these patients I would love to hear what you recommend!

Thanks for your help.

Missy Bizzarro RD, LD

WPAFB Medical Center

Dayton, OH

[Guest guest]

A routine blood test for something else came up with low blood sugar recently.

The nurse announced that I have hypoglycemia and need to go on the hypoglycemia

diet but didnt offer any help with that. So I have been reading up some and

trying to figure out what I can eat that I can manage with my available energy

for shopping and cooking. Any helpful web resources would be appreciated. I may

have to seek professional help to sort it all out given my various allergies

too.

Looking back, I know I have been warned before that I have a tendency to

hypoglycemia and I need to keep away from the empty carb calories and at times I

have been pretty good about it. The past few years or so, my sugar intake has

crept up, ironically, partially due to the increased availability of gluten free

snack foods that have too much sugar and the chocolate addiction flairing up. It

also appears to me that there may be a pretty big correlation between the

hypoglycemia and my anxiety attacks. Clearly some of them are provoked by

specific identifiable stressors at the time but some of them are not and I was

starting to suspect that sugar was playing some role in it. What I am reading is

that stress impacts the ability to process sugar correctlly and the adrenal

deficiency gets all mixed up in this. So, I get it that I need to clean up my

diet because I really cant deal with this level of sugar anymore.

Again, I am wondering if this is related to the CFS or just something specific

to my genetic makeup and environmental experience.

Beverly H