Re: GBP post-op hypoglycemia - help

[Guest guest]

What I've seen is that the doctors usually take them off insulin altogether and just watch their blood glucose readings for a while. A lot of times the blood sugars improve even before much weight loss occurs.

[Guest guest]

She needs her insulin regimen changed...big time. She might benefit from a basal of glargine at night with boluses of lispro to cover food...or the lack of it. Sounds like she needs a really good endo and/or CDE to help her with it. The RD/CDE can help her determine her particular CHO: insulin ratio and calculate how much insulin to take when she eats a certain amount of CHO. The pt has to be pretty motivated and responsible.

I am a CDE and have had diabetes for 28 yrs. That is how I handled it when I had the LapBand placed. But that had been my regimen for years. BTW, it might be interesting to note that although I have had an 75 pound wt loss I have not been able to reduce any meds. My A1Cs are improved a little but they were good anyway....bummer...

GBP post-op hypoglycemia - help

Saw a pre-op patient today who is worrying about how she will treathypoglycemia after surgery. Currently she uses glucose tablets and isafraid they will make her sick afterwards. I told her our main goal wouldbe to prevent the hypoglycemia and that her insulin regimen would need to beadjusted (currently on 70/30 big dose in pm and small dose in am). Shetends to go low about 4:00 am. Has h/o DM X 23 yrs, insulin from thestart with brief vacation from insulin a few years back. BG now about 120in am and > 200 in pm, sometimes 4-5 episodes of hypoglycemia a day. Diet -lots of emotional eating/snacking (simple CHO's). What do you think?Sandi Birch, RD LDEIRMC, Idaho Fallsneilandsandi@...>>>

[Guest guest]

If you ask me, she's on way too much insulin now. When she

has surgery, she will need very little, if any. Who is her

endocrinologist? That woman should have her insulin reduced

immediately! When is her surgery?

Nonas

North General Hospital

NYC

[Guest guest]

There is some research on glycemic control due to significant

reductions in calories, before significant weight loss. 30--

50% of the change in blood sugars occurs in the first 7-10

days. Someone who has had diabetes for 23 years may never be

able to do without medication (secondary to beta cell

dysfunction) but post surgery, medication needs will be much

much less.

Here are two studies that address it, but there are more:

Wing, Blair et al, Diabetes Care. 17: 30-36, 1994

Christiansen et al, Diabetes. 49:1691-1699, 2000

Nonas

North General Hospital

NYC