Medical Nutrition Therapy and Other Approaches to Management of Post-bariatric Hypoglycemia: A Team-Based Approach.
Nicole PatienceAmanda SheehanCameron CummingsMary Elizabeth PattiPublished in: Current obesity reports (2022)
As the number of bariatric surgeries rises yearly, with 256,000 performed in 2019, PBH is an increasingly encountered late complication. Following Roux-en-Y (RYGB) or vertical sleeve gastrectomy (VSG), about 1/3 of patients report symptoms suggestive of at least mild postprandial hypoglycemia, with severe and/or medically confirmed hypoglycemia in 1-10%. Anatomical alterations, changes in GLP1 and other intestinally derived hormones, excessive insulin response, reduced insulin clearance, impaired counterregulatory hormone response to hypoglycemia, and other factors contribute to PBH. MNT is the cornerstone of multidisciplinary treatment, with utilization of personal continuous glucose monitoring to improve safety when possible. While many individuals require pharmacotherapy, there are no currently approved medications for PBH. Increasing awareness and identification of individuals at risk for or with PBH is critical given the potential impact on safety, nutrition, and quality of life. A team-based approach involving the individual, the RDN, and other clinicians is essential in providing ongoing assessment and individualization of MNT in the long-term management of PBH.
Keyphrases
- type diabetes
- glycemic control
- roux en y gastric bypass
- weight loss
- gastric bypass
- palliative care
- blood glucose
- end stage renal disease
- physical activity
- ejection fraction
- newly diagnosed
- quality improvement
- healthcare
- peritoneal dialysis
- prognostic factors
- insulin resistance
- bariatric surgery
- weight gain
- smoking cessation
- risk assessment
- obese patients
- skeletal muscle
- stem cells
- body mass index
- depressive symptoms
- climate change
- drug induced
- human health