Re: IMPORTANT! PLEASE READ RE LOW BLOOD SUGAR

[Guest guest]

Robyn: Thank you for this very informative post. I am seeing my family

physician tomorrow and plan to discuss my hypoglycemia in more detail with him!

Janice

Robyn wrote: Low Blood Glucose Levels

May Complicate Gastric Bypass Surgery,

Study Shows

BOSTON—October 12, 2005—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). The paper, recently published online by the journal

Diabetologia and scheduled to be published in the journal's November

print edition, 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 - 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, " she adds. Dr. Patti and B. Goldfine, M.D., also an

Investigator at Joslin and Assistant Professor of Medicine at

Harvard Medical School, were co-investigators of the study.

The study reported on three patients – a woman in her 20s, another

in her 60s and a man in his 40s. All three lost significant amounts

of weight through gastric bypass surgery, putting them in the normal

Body Mass Index (BMI) range. Each, however, developed postprandial

hypoglycemia (low blood glucose after meals) that failed to respond

to dietary or medical intervention. As a result, all patients

required removal of part or all of the pancreas. In all three cases,

it was found that the insulin-producing islet cells in their

pancreases had proliferated abnormally.

A potential cause of this severe hypoglycemia in these patients

is " dumping syndrome, " a constellation of symptoms including

palpitations, lightheadedness, abdominal cramping and diarrhea,

explains Dr. Patti. Dumping syndrome occurs when the small intestine

fills too quickly with undigested food from the stomach, as can

happen following gastric bypass surgery. But the failure to respond

to dietary and medical therapy, and the conditions worsening over

time, suggested that additional pathology was needed to explain the

symptoms' severity, Dr. Patti adds. " The magnitude of the problem

was way beyond what doctors typically call dumping syndrome, " she

says.

Other causes of postprandial hypoglycemia can include overactive

islet cells, sometimes caused by excess numbers of cells, a tumor in

the pancreas that produces too much insulin or familial

hyperinsulinism (hereditary production of too much insulin), which

in severe cases can necessitate removal of the pancreas.

In patients following bariatric surgery, additional mechanisms may

contribute to overproduction of insulin. " First, insulin sensitivity

(responsiveness to insulin) improves after weight loss of any kind,

and can be quite significant after successful gastric surgery, " says

Dr. Patti. " Second, weight gain and obesity are associated with

increased numbers of insulin producing cells in the pancreas, and so

some patients may not reverse this process normally, leaving them

with inappropriately high numbers of beta cells. "

Finally, after gastric bypass surgery, GLP1 (glucagon-like peptide

1) and other hormones are secreted in abnormal patterns in response

to food intake, since the intestinal tract has been altered. High

levels of GLP1 may stimulate insulin secretion further and cause

increased numbers of insulin-producing cells. " In our patients, the

fact that the post-operative onset of hyperinsulinemia was not

immediate suggests that active expansion of the beta cell mass

contributed to the condition, " Dr. Patti adds.

Other researchers participating in the study included S. Bonner-

Weir, Ph.D., of Joslin; E.C. Mun, M.D., J.J. Holst, M.D., J.

Goldsmith, M.D., D.W. Hanto, M.D., Ph.D., M. Callery, M.D., of Beth

Israel Deaconess Medical Center. Collaborating investigators from

the Brigham and Women's Hospital included R. Arky, M.D., who also is

a Joslin Overseer, G.T. McMahon, M.D., M.M.Sc., A. Bitton, M.D., and

V. Nose, M.D. All participants are on faculty at the Harvard Medical

School. Funding for the study was provided by the National

Institutes of Health, the Henry Fund of BIDMC and the General

Clinical Research Centers.

Besides helping afflicted gastric bypass patients, the research has

hopeful implications for treating people with diabetes, says Dr.

Patti. The gastric bypass patients have what many of those with

diabetes lack – ample insulin – and perhaps an understanding of this

phenomenon could be harnessed to help those with diabetes. " If we

can understand what processes are responsible for too much insulin

production and too many islet cells in these patients, we may be

able to apply this information to stimulate insulin production in

patients with diabetes, who lack sufficient insulin, " Dr. Patti says.

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

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starting at 1¢/min.

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

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[Guest guest]

I was hypoglycemic going into the surgery and have found that if I don't

intake sugar during the day that I will get deathly ill. I have taken all

the artificial sweeteners out of my diet, and am only 3 months post at this

point. After reverting back to regular sugar with my diet, I don't get so

sick. I look at it this way, its 16 calories for a tsp of sugar.. so.. I can

cope.

_____

From: GastricBypass-LOSERS

[mailto:GastricBypass-LOSERS ] On Behalf Of Ima Winner

Sent: Thursday, September 07, 2006 8:24 AM

To: GastricBypass-LOSERS

Subject: Re: IMPORTANT! PLEASE READ RE LOW BLOOD

SUGAR

Robyn: Thank you for this very informative post. I am seeing my family

physician tomorrow and plan to discuss my hypoglycemia in more detail with

him! Janice

Robyn <LOSERS@GastricBypas <mailto:LOSERS%40GastricBypassLosers.com>

sLosers.com> wrote: Low Blood Glucose Levels May Complicate Gastric Bypass

Surgery,

Study Shows

BOSTON—October 12, 2005—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). The paper, recently published online by the journal

Diabetologia and scheduled to be published in the journal's November

print edition, 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 - 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, " she adds. Dr. Patti and B. Goldfine, M.D., also an

Investigator at Joslin and Assistant Professor of Medicine at

Harvard Medical School, were co-investigators of the study.

The study reported on three patients – a woman in her 20s, another

in her 60s and a man in his 40s. All three lost significant amounts

of weight through gastric bypass surgery, putting them in the normal

Body Mass Index (BMI) range. Each, however, developed postprandial

hypoglycemia (low blood glucose after meals) that failed to respond

to dietary or medical intervention. As a result, all patients

required removal of part or all of the pancreas. In all three cases,

it was found that the insulin-producing islet cells in their

pancreases had proliferated abnormally.

A potential cause of this severe hypoglycemia in these patients

is " dumping syndrome, " a constellation of symptoms including

palpitations, lightheadedness, abdominal cramping and diarrhea,

explains Dr. Patti. Dumping syndrome occurs when the small intestine

fills too quickly with undigested food from the stomach, as can

happen following gastric bypass surgery. But the failure to respond

to dietary and medical therapy, and the conditions worsening over

time, suggested that additional pathology was needed to explain the

symptoms' severity, Dr. Patti adds. " The magnitude of the problem

was way beyond what doctors typically call dumping syndrome, " she

says.

Other causes of postprandial hypoglycemia can include overactive

islet cells, sometimes caused by excess numbers of cells, a tumor in

the pancreas that produces too much insulin or familial

hyperinsulinism (hereditary production of too much insulin), which

in severe cases can necessitate removal of the pancreas.

In patients following bariatric surgery, additional mechanisms may

contribute to overproduction of insulin. " First, insulin sensitivity

(responsiveness to insulin) improves after weight loss of any kind,

and can be quite significant after successful gastric surgery, " says

Dr. Patti. " Second, weight gain and obesity are associated with

increased numbers of insulin producing cells in the pancreas, and so

some patients may not reverse this process normally, leaving them

with inappropriately high numbers of beta cells. "

Finally, after gastric bypass surgery, GLP1 (glucagon-like peptide

1) and other hormones are secreted in abnormal patterns in response

to food intake, since the intestinal tract has been altered. High

levels of GLP1 may stimulate insulin secretion further and cause

increased numbers of insulin-producing cells. " In our patients, the

fact that the post-operative onset of hyperinsulinemia was not

immediate suggests that active expansion of the beta cell mass

contributed to the condition, " Dr. Patti adds.

Other researchers participating in the study included S. Bonner-

Weir, Ph.D., of Joslin; E.C. Mun, M.D., J.J. Holst, M.D., J.

Goldsmith, M.D., D.W. Hanto, M.D., Ph.D., M. Callery, M.D., of Beth

Israel Deaconess Medical Center. Collaborating investigators from

the Brigham and Women's Hospital included R. Arky, M.D., who also is

a Joslin Overseer, G.T. McMahon, M.D., M.M.Sc., A. Bitton, M.D., and

V. Nose, M.D. All participants are on faculty at the Harvard Medical

School. Funding for the study was provided by the National

Institutes of Health, the Henry Fund of BIDMC and the General

Clinical Research Centers.

Besides helping afflicted gastric bypass patients, the research has

hopeful implications for treating people with diabetes, says Dr.

Patti. The gastric bypass patients have what many of those with

diabetes lack – ample insulin – and perhaps an understanding of this

phenomenon could be harnessed to help those with diabetes. " If we

can understand what processes are responsible for too much insulin

production and too many islet cells in these patients, we may be

able to apply this information to stimulate insulin production in

patients with diabetes, who lack sufficient insulin, " Dr. Patti says.

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

Talk is cheap. Use Yahoo! Messenger to make PC-to-Phone calls. Great rates

starting at 1¢/min.

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

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[Guest guest]

Robyn,

Well that is enough to scare the bageesees out of me! I like my pancreas

right where it is!

Mike T

IMPORTANT! PLEASE READ RE LOW BLOOD SUGAR

Low Blood Glucose Levels May Complicate Gastric Bypass Surgery,

Study Shows

[Guest guest]

I am on the phone with my doctor as I type. First let me say...this

is why I love this group...I get so much information. I have had

episodes just like these...I have to say that I thought it was just

about me eating bad. But as I read the article I look back and

realize it happens whenever. I do notice that if I don't eat protein

it happens more often. two weeks ago I was at work and I had a bagel

and grapes for breakfast...so as the morning went on I started

feeling light headed...then I started shaking and the sweats came.

So I went back to my desk and I felt dizzy. My co-worker went to the

store and bought me a turkey sandwich...while I was waiting for him I

ate a piece of chocolate...but that was not working...but when he did

get back with the meat and cheese and I took a few bites...the

symptoms disappeared. Then I was in the movies over the weekend. I

had a fish sandwich earlier that day and some nathans fries (yes I

know...I need help). So I was in the movies and had some popcorn and

yes it had butter...and as I was sitting there I felt myself starting

to shake and my head getting light. My friend had some meat in her

bag...don't even ask...and when I ate the meat I was better. I

thought it was dumping but as I read this article I have to wonder.

I am on my way to the doctor really soon. So glad I read this. We

really have to take care of ourselves or we will have serious

problems.

>

> Low Blood Glucose Levels May Complicate Gastric Bypass Surgery,

> Study Shows

>

> BOSTON—October 12, 2005—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). The paper, recently published online by the journal

> Diabetologia and scheduled to be published in the journal's

November

> print edition, 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 - 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, " she adds. Dr. Patti and B. Goldfine, M.D., also

an

> Investigator at Joslin and Assistant Professor of Medicine at

> Harvard Medical School, were co-investigators of the study.

>

> The study reported on three patients – a woman in her 20s, another

> in her 60s and a man in his 40s. All three lost significant amounts

> of weight through gastric bypass surgery, putting them in the

normal

> Body Mass Index (BMI) range. Each, however, developed postprandial

> hypoglycemia (low blood glucose after meals) that failed to respond

> to dietary or medical intervention. As a result, all patients

> required removal of part or all of the pancreas. In all three

cases,

> it was found that the insulin-producing islet cells in their

> pancreases had proliferated abnormally.

>

> A potential cause of this severe hypoglycemia in these patients

> is " dumping syndrome, " a constellation of symptoms including

> palpitations, lightheadedness, abdominal cramping and diarrhea,

> explains Dr. Patti. Dumping syndrome occurs when the small

intestine

> fills too quickly with undigested food from the stomach, as can

> happen following gastric bypass surgery. But the failure to respond

> to dietary and medical therapy, and the conditions worsening over

> time, suggested that additional pathology was needed to explain the

> symptoms' severity, Dr. Patti adds. " The magnitude of the problem

> was way beyond what doctors typically call dumping syndrome, " she

> says.

>

> Other causes of postprandial hypoglycemia can include overactive

> islet cells, sometimes caused by excess numbers of cells, a tumor

in

> the pancreas that produces too much insulin or familial

> hyperinsulinism (hereditary production of too much insulin), which

> in severe cases can necessitate removal of the pancreas.

>

> In patients following bariatric surgery, additional mechanisms may

> contribute to overproduction of insulin. " First, insulin

sensitivity

> (responsiveness to insulin) improves after weight loss of any kind,

> and can be quite significant after successful gastric surgery, "

says

> Dr. Patti. " Second, weight gain and obesity are associated with

> increased numbers of insulin producing cells in the pancreas, and

so

> some patients may not reverse this process normally, leaving them

> with inappropriately high numbers of beta cells. "

>

> Finally, after gastric bypass surgery, GLP1 (glucagon-like peptide

> 1) and other hormones are secreted in abnormal patterns in response

> to food intake, since the intestinal tract has been altered. High

> levels of GLP1 may stimulate insulin secretion further and cause

> increased numbers of insulin-producing cells. " In our patients, the

> fact that the post-operative onset of hyperinsulinemia was not

> immediate suggests that active expansion of the beta cell mass

> contributed to the condition, " Dr. Patti adds.

>

> Other researchers participating in the study included S. Bonner-

> Weir, Ph.D., of Joslin; E.C. Mun, M.D., J.J. Holst, M.D., J.

> Goldsmith, M.D., D.W. Hanto, M.D., Ph.D., M. Callery, M.D., of Beth

> Israel Deaconess Medical Center. Collaborating investigators from

> the Brigham and Women's Hospital included R. Arky, M.D., who also

is

> a Joslin Overseer, G.T. McMahon, M.D., M.M.Sc., A. Bitton, M.D.,

and

> V. Nose, M.D. All participants are on faculty at the Harvard

Medical

> School. Funding for the study was provided by the National

> Institutes of Health, the Henry Fund of BIDMC and the General

> Clinical Research Centers.

>

> Besides helping afflicted gastric bypass patients, the research has

> hopeful implications for treating people with diabetes, says Dr.

> Patti. The gastric bypass patients have what many of those with

> diabetes lack – ample insulin – and perhaps an understanding of

this

> phenomenon could be harnessed to help those with diabetes. " If we

> can understand what processes are responsible for too much insulin

> production and too many islet cells in these patients, we may be

> able to apply this information to stimulate insulin production in

> patients with diabetes, who lack sufficient insulin, " Dr. Patti

says.

>

[Guest guest]

Thank you so much for this informative article. After reading your comments, I

realized this is what was happening to me a few years back as I crashed dieted

my way. I was also a strict vegetarian, eating mostly salads. I never told

anyone of my symptoms, but that is exactly what use to happen. I have since

stopped crash dieting, but have also gained all the weight back.

At least I know what too look for once I have my surgery, I won't be so naive.

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

Yahoo! Messenger with Voice. Make PC-to-Phone Calls to the US (and 30+

countries) for 2¢/min or less.

[Guest guest]

Jane,

I wish I could have you meet this lady that is in my water aerobics

class.......She was like 95% through the process to get her surgery, she

only was waiting for a date.....Then she got scared and backed out, she said

she could diet and do it on her own......I was polite and wished her good

luck and all that good stuff, but as we all know doing it on our own does

not work, that is why we were in the process for the surgery in the first

place! I wish her the best, but deep inside I feel that she will fail like

most of us have on our own, I wish she had reconsidered, but I never want to

try and talk somebody into something as huge a decision as this one. I wish

you great luck with your surgery, and I know you will do awesome.

Mike T

Re: Re: IMPORTANT! PLEASE READ RE LOW BLOOD

SUGAR

Thank you so much for this informative article. After reading your

comments, I realized this is what was happening to me a few years back as I

crashed dieted my way. I was also a strict vegetarian, eating mostly salads.

I never told anyone of my symptoms, but that is exactly what use to happen.

I have since stopped crash dieting, but have also gained all the weight

back.

At least I know what too look for once I have my surgery, I won't be so

naive.

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

Yahoo! Messenger with Voice. Make PC-to-Phone Calls to the US (and 30+

countries) for 2¢/min or less.

[Guest guest]

OMG! Now I am really worried! I got pancreatitis two weeks after the surgery

and was rehospitalized for 2 weeks in severe pain, without food, and had a

feeding line in my jugular. I frequently experience the lightheadedness and

ringing in my ears. With already having experienced a problem with my pancreas,

I wonder now if I am going to have to have mine removed. I haven't seen the doc

since the lightheadedness and ringing began about a month ago and I don't see

him until next month. I wonder if I ought to contact him and tell him what is

happening. I am really scared now. :-(

IMPORTANT! PLEASE READ RE LOW BLOOD SUGAR

Low Blood Glucose Levels May Complicate Gastric Bypass Surgery,

Study Shows

BOSTON-October 12, 2005-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). The paper, recently published online by the journal

Diabetologia and scheduled to be published in the journal's November

print edition, 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 - 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, " she adds. Dr. Patti and B. Goldfine, M.D., also an

Investigator at Joslin and Assistant Professor of Medicine at

Harvard Medical School, were co-investigators of the study.

The study reported on three patients - a woman in her 20s, another

in her 60s and a man in his 40s. All three lost significant amounts

of weight through gastric bypass surgery, putting them in the normal

Body Mass Index (BMI) range. Each, however, developed postprandial

hypoglycemia (low blood glucose after meals) that failed to respond

to dietary or medical intervention. As a result, all patients

required removal of part or all of the pancreas. In all three cases,

it was found that the insulin-producing islet cells in their

pancreases had proliferated abnormally.

A potential cause of this severe hypoglycemia in these patients

is " dumping syndrome, " a constellation of symptoms including

palpitations, lightheadedness, abdominal cramping and diarrhea,

explains Dr. Patti. Dumping syndrome occurs when the small intestine

fills too quickly with undigested food from the stomach, as can

happen following gastric bypass surgery. But the failure to respond

to dietary and medical therapy, and the conditions worsening over

time, suggested that additional pathology was needed to explain the

symptoms' severity, Dr. Patti adds. " The magnitude of the problem

was way beyond what doctors typically call dumping syndrome, " she

says.

Other causes of postprandial hypoglycemia can include overactive

islet cells, sometimes caused by excess numbers of cells, a tumor in

the pancreas that produces too much insulin or familial

hyperinsulinism (hereditary production of too much insulin), which

in severe cases can necessitate removal of the pancreas.

In patients following bariatric surgery, additional mechanisms may

contribute to overproduction of insulin. " First, insulin sensitivity

(responsiveness to insulin) improves after weight loss of any kind,

and can be quite significant after successful gastric surgery, " says

Dr. Patti. " Second, weight gain and obesity are associated with

increased numbers of insulin producing cells in the pancreas, and so

some patients may not reverse this process normally, leaving them

with inappropriately high numbers of beta cells. "

Finally, after gastric bypass surgery, GLP1 (glucagon-like peptide

1) and other hormones are secreted in abnormal patterns in response

to food intake, since the intestinal tract has been altered. High

levels of GLP1 may stimulate insulin secretion further and cause

increased numbers of insulin-producing cells. " In our patients, the

fact that the post-operative onset of hyperinsulinemia was not

immediate suggests that active expansion of the beta cell mass

contributed to the condition, " Dr. Patti adds.

Other researchers participating in the study included S. Bonner-

Weir, Ph.D., of Joslin; E.C. Mun, M.D., J.J. Holst, M.D., J.

Goldsmith, M.D., D.W. Hanto, M.D., Ph.D., M. Callery, M.D., of Beth

Israel Deaconess Medical Center. Collaborating investigators from

the Brigham and Women's Hospital included R. Arky, M.D., who also is

a Joslin Overseer, G.T. McMahon, M.D., M.M.Sc., A. Bitton, M.D., and

V. Nose, M.D. All participants are on faculty at the Harvard Medical

School. Funding for the study was provided by the National

Institutes of Health, the Henry Fund of BIDMC and the General

Clinical Research Centers.

Besides helping afflicted gastric bypass patients, the research has

hopeful implications for treating people with diabetes, says Dr.

Patti. The gastric bypass patients have what many of those with

diabetes lack - ample insulin - and perhaps an understanding of this

phenomenon could be harnessed to help those with diabetes. " If we

can understand what processes are responsible for too much insulin

production and too many islet cells in these patients, we may be

able to apply this information to stimulate insulin production in

patients with diabetes, who lack sufficient insulin, " Dr. Patti says.

[Guest guest]

Racheal,

I think if you are that worried you should call and ask his opinion. It is

good that you are paying attention to your body, listen to it. Don't be scared,

just check up with him and that will make you feel better till your next appt.

Hugs,

Shauna

" R.D. Abernathy " wrote:

OMG! Now I am really worried! I got pancreatitis two weeks after the

surgery and was rehospitalized for 2 weeks in severe pain, without food, and had

a feeding line in my jugular. I frequently experience the lightheadedness and

ringing in my ears. With already having experienced a problem with my pancreas,

I wonder now if I am going to have to have mine removed. I haven't seen the doc

since the lightheadedness and ringing began about a month ago and I don't see

him until next month. I wonder if I ought to contact him and tell him what is

happening. I am really scared now. :-(

IMPORTANT! PLEASE READ RE LOW BLOOD SUGAR

Low Blood Glucose Levels May Complicate Gastric Bypass Surgery,

Study Shows

BOSTON-October 12, 2005-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). The paper, recently published online by the journal

Diabetologia and scheduled to be published in the journal's November

print edition, 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 - 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, " she adds. Dr. Patti and B. Goldfine, M.D., also an

Investigator at Joslin and Assistant Professor of Medicine at

Harvard Medical School, were co-investigators of the study.

The study reported on three patients - a woman in her 20s, another

in her 60s and a man in his 40s. All three lost significant amounts

of weight through gastric bypass surgery, putting them in the normal

Body Mass Index (BMI) range. Each, however, developed postprandial

hypoglycemia (low blood glucose after meals) that failed to respond

to dietary or medical intervention. As a result, all patients

required removal of part or all of the pancreas. In all three cases,

it was found that the insulin-producing islet cells in their

pancreases had proliferated abnormally.

A potential cause of this severe hypoglycemia in these patients

is " dumping syndrome, " a constellation of symptoms including

palpitations, lightheadedness, abdominal cramping and diarrhea,

explains Dr. Patti. Dumping syndrome occurs when the small intestine

fills too quickly with undigested food from the stomach, as can

happen following gastric bypass surgery. But the failure to respond

to dietary and medical therapy, and the conditions worsening over

time, suggested that additional pathology was needed to explain the

symptoms' severity, Dr. Patti adds. " The magnitude of the problem

was way beyond what doctors typically call dumping syndrome, " she

says.

Other causes of postprandial hypoglycemia can include overactive

islet cells, sometimes caused by excess numbers of cells, a tumor in

the pancreas that produces too much insulin or familial

hyperinsulinism (hereditary production of too much insulin), which

in severe cases can necessitate removal of the pancreas.

In patients following bariatric surgery, additional mechanisms may

contribute to overproduction of insulin. " First, insulin sensitivity

(responsiveness to insulin) improves after weight loss of any kind,

and can be quite significant after successful gastric surgery, " says

Dr. Patti. " Second, weight gain and obesity are associated with

increased numbers of insulin producing cells in the pancreas, and so

some patients may not reverse this process normally, leaving them

with inappropriately high numbers of beta cells. "

Finally, after gastric bypass surgery, GLP1 (glucagon-like peptide

1) and other hormones are secreted in abnormal patterns in response

to food intake, since the intestinal tract has been altered. High

levels of GLP1 may stimulate insulin secretion further and cause

increased numbers of insulin-producing cells. " In our patients, the

fact that the post-operative onset of hyperinsulinemia was not

immediate suggests that active expansion of the beta cell mass

contributed to the condition, " Dr. Patti adds.

Other researchers participating in the study included S. Bonner-

Weir, Ph.D., of Joslin; E.C. Mun, M.D., J.J. Holst, M.D., J.

Goldsmith, M.D., D.W. Hanto, M.D., Ph.D., M. Callery, M.D., of Beth

Israel Deaconess Medical Center. Collaborating investigators from

the Brigham and Women's Hospital included R. Arky, M.D., who also is

a Joslin Overseer, G.T. McMahon, M.D., M.M.Sc., A. Bitton, M.D., and

V. Nose, M.D. All participants are on faculty at the Harvard Medical

School. Funding for the study was provided by the National

Institutes of Health, the Henry Fund of BIDMC and the General

Clinical Research Centers.

Besides helping afflicted gastric bypass patients, the research has

hopeful implications for treating people with diabetes, says Dr.

Patti. The gastric bypass patients have what many of those with

diabetes lack - ample insulin - and perhaps an understanding of this

phenomenon could be harnessed to help those with diabetes. " If we

can understand what processes are responsible for too much insulin

production and too many islet cells in these patients, we may be

able to apply this information to stimulate insulin production in

patients with diabetes, who lack sufficient insulin, " Dr. Patti says.

[Guest guest]

I had the same thing happen w/ a friend of mine at work. She was all

schedule for her surgery. Her's was going to be 10 days before mine. I

was so excited to have a " buddy " to go thru this with. We got back to

work from summer break & she'd backed out. I was so bummed. She said

the same thing...she'd try one more time.

W

380/310/160

Mike Tune wrote:

> Jane,

> I wish I could have you meet this lady that is in my water aerobics

> class.......She was like 95% through the process to get her surgery, she

> only was waiting for a date.....Then she got scared and backed out, she said

> she could diet and do it on her own......I was polite and wished her good

> luck and all that good stuff, but as we all know doing it on our own does

> not work, that is why we were in the process for the surgery in the first

> place! I wish her the best, but deep inside I feel that she will fail like

> most of us have on our own, I wish she had reconsidered, but I never want to

> try and talk somebody into something as huge a decision as this one. I wish

> you great luck with your surgery, and I know you will do awesome.

>

> Mike T

>

>