POSTPARIATRIC HYPOGLYCEMIA Flashcards
What is Postbariatric Hypoglycemia?
Rare but increasingly frequent complication of bariatric surgery
When does Postbariatric Hypoglycemia typically occur?
At least 6 months post-surgery
What are the symptoms of Postbariatric Hypoglycemia?
- Frequent postprandial hypoglycemia
- Altered mental status
- Visual changes
- Motor incoordination
- Loss of consciousness
- Seizures
What triggers hyperinsulinemia in Postbariatric Hypoglycemia?
Oral glucose, not intravenous glucose
What is the underlying physiology of Postbariatric Hypoglycemia?
- Inappropriately high insulin secretion after nutrient ingestion
- Elevated GLP-1 levels after meals
- GLP-1 hypersecretion and hypoglycemia reversible with gastrostomy tube feeding
What does the altered nutrient transit with foregut bypass and hindgut stimulation do in Postbariatric Hypoglycemia?
Exacerbates hypoglycemia via GLP-1
What is the Whipple triad used for in the diagnosis of Postbariatric Hypoglycemia?
Fulfillment of the triad indicates symptomatic hypoglycemia
What is a mixed-meal challenge used for in the diagnosis?
To identify symptomatic hypoglycemia
What initial dietary counseling is recommended for Postbariatric Hypoglycemia?
- Eliminate refined starches
- Use high-fiber, low-glycemic index foods
What glucosidase inhibitor is recommended for Postbariatric Hypoglycemia?
Acarbose
What are the other treatments if acarbose is insufficient?
- Diazoxide
- Octreotide
What is the role of gastric bypass reversal in treating Postbariatric Hypoglycemia?
No role for gastric bypass reversal
What is effective in reversing hypoglycemia in Postbariatric Hypoglycemia?
Gastrostomy tube feeding
Is a ketogenic diet applicable to Postbariatric Hypoglycemia?
Not applicable
What is the evidence for Liraglutide in treating Postbariatric Hypoglycemia?
Limited evidence for this condition
