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Postprandial Hypoglycemia

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1. An unusual presentation of post gastric bypass hypoglycemia with both postprandial and fasting hypoglycemia (PubMed)

An unusual presentation of post gastric bypass hypoglycemia with both postprandial and fasting hypoglycemia There has been an increasing awareness of post gastric bypass hypoglycemia (PGBH). Histopathologic findings from such patients who underwent partial/total pancreatomy, however, can vary widely from minimal changes to classic nesidioblastosis, making the pathologic diagnosis challenging. PGBH typically presents as postprandial hypoglycemia, as opposed to insulinoma, which presents (...) as fasting hypoglycemia. Herein, we describe an unusual case of a patient with PGBH who initially presented with postprandial hypoglycemia three years after surgery, but later developed fasting hyperinsulinemic hypoglycemia as the disease progressed. Our hypothesis for this phenomenon is that this disease is progressive, and later in its course, the insulin release becomes dissociated from food stimulation and is increased at baseline. Future studies are needed to investigate the prevalence as well

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2018 Endocrinology, diabetes & metabolism case reports

2. Mechanisms of action of a carbohydrate-reduced, high-protein diet in reducing the risk of postprandial hypoglycemia after Roux-en-Y gastric bypass surgery. (PubMed)

Mechanisms of action of a carbohydrate-reduced, high-protein diet in reducing the risk of postprandial hypoglycemia after Roux-en-Y gastric bypass surgery. Postprandial hypoglycemia is a risk after Roux-en-Y gastric bypass (RYGB).We speculated that a carbohydrate-reduced, high-protein (CRHP) diet might reduce the risk of hypoglycemia and therefore compared the acute effects of a conventionally recommended (CR) diet and CRHP diet [55/30 energy percent (E%) carbohydrate and 15/30 E% protein (...) , respectively] in RYGB patients.Ten individuals (2 males, 8 females, mean ± SD age 47 ± 7 y; stable body mass index 31 ± 6 kg/m2; 6 ± 3 y post-RYGB) with recurrent postprandial hypoglycemia documented by plasma glucose (PG) ≤3.4 mmol/L were examined on 2 d with isoenergetic CRHP or CR diets comprising a breakfast and subsequent lunch meal.Peak PG was significantly reduced on the CRHP diet after breakfast and lunch by 11% and 31% compared with the CR diet. Nadir PG increased significantly on CRHP (by 13

2019 American Journal of Clinical Nutrition

3. The role of vagal activation in postprandial glucose metabolism after gastric bypass in individuals with and without hypoglycemia. (PubMed)

The role of vagal activation in postprandial glucose metabolism after gastric bypass in individuals with and without hypoglycemia. Patients with gastric bypass surgery (GB) have enhanced postprandial hyperinsulinemia and incretin effect. Here we sought to determine the effect of vagal activation, a neural component of the enteroinsular axis, on postprandial glucose metabolism in patients with and without hypoglycemia after GB. Seven subjects with documented post-GB hypoglycemia (HGB), 7 GB (...) subjects without hypoglycemia (AGB), and 10 weight-matched non-surgical controls with normal glucose tolerance (CN) were recruited. Blood glucose, and islet hormone and incretin secretion were compared during mixed meal tolerance tests (MTT) with and without prior sham-feeding on two separate days. Sham feeding preceding the MTT caused a more rapid increase in prandial blood glucose but lowered overall glycemia in all 3 groups (p<0.05). Sham feeding had a comparable effect to increase early (p<0.05

2019 obesity & metabolism

4. Risk-based postprandial hypoglycemia forecasting using supervised learning. (PubMed)

Risk-based postprandial hypoglycemia forecasting using supervised learning. Predicting insulin-induced postprandial hypoglycemic events is critical for the safety of type 1 diabetes patients because an early warning of hypoglycemia facilitates correction of the insulin bolus before its administration. The postprandial hypoglycemic event counts can be lowered by reducing the size of the bolus based on a reliable prediction but at the cost of increasing the average blood glucose.We developed (...) a method for predicting postprandial hypoglycemia using machine learning techniques personalized to each patient. The proposed system enables on-line therapeutic decision making for patients using a sensor augmented pump therapy. Two risk-based approaches were developed for a window of 240 min after the meal/bolus, and they were tested based on real retrospective data from 10 patients using 70 mg/dL and 54 mg/dL as thresholds according to the consensus for Level 1 and Level 2 hypoglycemia, respectively

2019 International journal of medical informatics

5. Possible relation between partial small bowel obstruction and severe postprandial reactive hypoglycemia after Roux-en-Y gastric bypass. (PubMed)

Possible relation between partial small bowel obstruction and severe postprandial reactive hypoglycemia after Roux-en-Y gastric bypass. Although dietary treatment ameliorates symptoms in most patients with postbariatric hypoglycemia (PBH), there is a subgroup with severe symptoms that do not respond sufficiently to either diet or drugs. A clinical observation showed that those patients additionally experienced postprandial abdominal discomfort or pain.This report describes patients with severe (...) corrective surgery (adhesiolysis and/or a reconstructed jejuno-jejunostomy). Out of 21 patients using medications to control hypoglycemia before corrective surgery, 19 (90.5%) discontinued the medication, and 5 of 19 (26%) no longer needed to use a blood glucometer or a continuous glucose monitor. Although patients after surgical correction still could experience PBH, symptoms were less frequent and less severe. Postprandial abdominal symptoms decreased, and patients reported improved eating quality

2019 Surgery for Obesity and Related Diseases

6. Postprandial hypoglycemia after gastric bypass surgery: from pathogenesis to diagnosis and treatment. (PubMed)

Postprandial hypoglycemia after gastric bypass surgery: from pathogenesis to diagnosis and treatment. The Roux-en-Y gastric bypass surgery (RYGB) improves glucose control in majority of patients with type 2 diabetes. However, a minority group of individuals develop a life-threatening complication of hyperinsulinemic hypoglycemia. The goal of this review is to identify underlying mechanisms by which RYGB cause hypoglycemia and describe pathogenesis-driven strategies to diagnose and treat (...) of prandial hyperinsulinemia. The exaggerated effect of RYGB on postmeal glucose metabolism is a syndrome of postprandial hyperinsulinemic hypoglycemia manifesting in a group of individuals several years after this surgery. Affected patients have larger systemic appearance of ingested glucose and greater postmeal secretion of insulin and GLP-1 compared to those with history of RYGB without symptomatic hypoglycemia. Current evidence supporting a multifactorial model of glucose dysregulation among patients

2019 Current opinion in clinical nutrition and metabolic care

7. Evaluation of postprandial hypoglycemia in patients with nonalcoholic fatty liver disease by oral glucose tolerance testing and continuous glucose monitoring (PubMed)

Evaluation of postprandial hypoglycemia in patients with nonalcoholic fatty liver disease by oral glucose tolerance testing and continuous glucose monitoring Nonalcoholic fatty liver disease (NAFLD) is often associated with insulin resistance and glucose intolerance. Postprandial hypoglycemia frequently occurs in NAFLD patients; however, the details remain unclear.The 75-g oral glucose tolerance test (75gOGTT) in 502 patients with biopsy-proven NAFLD and continuous glucose monitoring (CGM (...) ) in 20 patients were performed, and the characteristics and causes of postprandial hypoglycemia were investigated.The proportion of patients in the Hypo subgroup [plasma glucose (PG) at 180 min

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2018 European journal of gastroenterology & hepatology

8. Fasting levels of glicentin are higher in Roux-en-Y gastric bypass patients exhibiting postprandial hypoglycemia during a meal test. (PubMed)

Fasting levels of glicentin are higher in Roux-en-Y gastric bypass patients exhibiting postprandial hypoglycemia during a meal test. Post-bypass postprandial hypoglycemia (PPH) is a frequent complication of Roux-en-Y Gastric Bypass (RYGB) but predictors remain poorly identified and are needed to assess individual risk. After RYGB, exaggerated secretion of glucagon-like peptide-1 (GLP-1) and insulin could lead to PPH, but other proglucagon-derived peptides, including glicentin and glucagon (...) , could also contribute to this phenomenon.To identify biological hypoglycemia in relation to the secretion of proglucagon-derived peptides during a mixed-meal test (MMT) in RYGB patients.University hospital.Twenty RYGB patients reporting symptoms consistent with PPH were examined 36.9 ± 5.1 months after surgery. Plasma levels of glucose, c-peptide, glucagon, GLP-1 and glicentin were assessed before and during MMT. Patients with postprandial hypoglycemia ≤3 mM (54 mg/dL) during MMT were assigned

2018 Surgery for Obesity and Related Diseases

9. Postprandial Hypoglycemia. Complication of Peptic Ulcer Surgery. (PubMed)

Postprandial Hypoglycemia. Complication of Peptic Ulcer Surgery. Billroth II procedures (gastrojejunostomy with vagotomy) are seldom performed now but were popular before the advent of histamine 2 receptor blockers and proton pump inhibitors. Such procedures can be a cause of late postprandial hypoglycemia.We performed a formal evaluation and discussion of postprandial hypoglycemia.We present a case of an 85-year-old man who presented to the endocrinology clinic with symptoms of "fainting (...) spells after large meals." The patient previously had extensive evaluations by a neurologist and a cardiologist. Because of the history of Billroth II surgery and the description of his fainting spells, a 5-hour glucose tolerance test was performed in the clinic using the foods that uniformly resulted in symptoms. This confirmed that the late dumping syndrome with associated hypoglycemia was the cause of his spells.Late dumping syndrome manifesting with hypoglycemia should be considered in the workup

2017 American Journal of Medicine

10. Is testing for postprandial hyperinsulinemic hypoglycemia after gastric bypass necessary? (PubMed)

Is testing for postprandial hyperinsulinemic hypoglycemia after gastric bypass necessary? Postprandial hyperinsulinemic hypoglycemia (pHH) is an increasingly reported complication after Roux-en-Y gastric bypass (RYGB). As pHH can cause life-threatening emergencies if occurring without warning symptoms, challenge testing may detect patients at risk. The study objective was to determine the frequency of occurrence of pHH with or without symptoms of hypoglycemia after RYGB.We undertook (...) an observational cohort study of consecutive, unselected patients approximately one year after uncomplicated RYGB. To simulate normal habits, all patients received a standardized carbohydrate-rich solid mixed meal. Plasma glucose and insulin were measured at 30, 60, 90, 120, and 150 min thereafter. Symptoms were classified as autonomous or neuroglycopenic. Patients with hypoglycemia (plasma glucose <3.0 mmol/L [55 mg/dL]), were tested a second time with a protein-rich solid mixed meal.113 patients were

2017 Clinical nutrition (Edinburgh, Scotland)

11. Postprandial Hypoglycemia in Patients After Bariatric Surgery With Empagliflozin and Anakinra

Postprandial Hypoglycemia in Patients After Bariatric Surgery With Empagliflozin and Anakinra Postprandial Hypoglycemia in Patients After Bariatric Surgery With Empagliflozin and Anakinra - The Hypo-BEAR-Study - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100 (...) ). Please remove one or more studies before adding more. Postprandial Hypoglycemia in Patients After Bariatric Surgery With Empagliflozin and Anakinra - The Hypo-BEAR-Study (Hypo-BEAR) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03200782 Recruitment Status : Completed First Posted : June 27, 2017

2017 Clinical Trials

12. Postprandial hyperinsulinemic hypoglycemia after gastric bypass surgical treatment. (PubMed)

Postprandial hyperinsulinemic hypoglycemia after gastric bypass surgical treatment. An association between post-Roux-en-Y gastric bypass (RYGB) hypoglycemia and nesidioblastosis was reported in 2005 and may cause serious neuroglycopenic symptoms. Most patients with postprandial hypoglycemia after RYGB respond to nutritional and medical treatment. A subset of patients, however, may not respond adequately and surgery may be considered. This review describes the current experience with surgical (...) intervention for severe post-RYGB hypoglycemia. PubMed and MEDLINE searches were made for reports describing clinical outcome after such surgery. Fourteen papers including 75 patients were identified. Different surgical interventions were applied including gastric tube placement, reversal of the bypass with and without concomitant sleeve resection, gastric pouch restriction, and pancreatic resection and reresection. Pancreatic resection was performed in 51 (68%) patients, 17 (23%) had RYGB reversal

2017 Surgery for Obesity and Related Diseases

13. Insulin Autoimmune Syndrome: a rare cause of postprandial hypoglycemia (PubMed)

Insulin Autoimmune Syndrome: a rare cause of postprandial hypoglycemia A 65-year-old obese Caucasian woman presented with symptomatic postprandial hypoglycemic episodes, resolution of symptoms with carbohydrate intake and significantly elevated anti-insulin antibody levels. She did not have any evidence for the use of oral antidiabetic medications, insulin, herbal substances, performing strenuous exercise or history of bariatric surgery. Fingerstick blood glucose readings revealed blood sugar (...) -hydroxybutyrate 0.12 mmol/L (n: 0.02-0.27) anti-insulin antibody >45.4 U/mL (n: <0.4). The result obtained while screening for serum sulfonylurea and meglitinides was negative. The repeated episodes of postprandial hypoglycemia associated with significantly elevated anti-insulin antibodies led to a diagnosis of insulin antibody syndrome (IAS). Significant improvement of hypoglycemic symptoms and lower anti-insulin antibody levels (33 U/mL) was noted on nutritional management during the following 6 months

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2016 Endocrinology, diabetes & metabolism case reports

14. A Pilot Study Evaluating Exenatide for the Treatment of Postprandial Hyperinsulinemic Hypoglycemia Post-RYGB

A Pilot Study Evaluating Exenatide for the Treatment of Postprandial Hyperinsulinemic Hypoglycemia Post-RYGB A Pilot Study Evaluating Exenatide for the Treatment of Postprandial Hyperinsulinemic Hypoglycemia Post-RYGB - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (...) (100). Please remove one or more studies before adding more. A Pilot Study Evaluating Exenatide for the Treatment of Postprandial Hyperinsulinemic Hypoglycemia Post-RYGB The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier

2016 Clinical Trials

15. Postprandial hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass: an update. (PubMed)

Postprandial hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass: an update. Roux-en-Y gastric bypass (RYGB) is an efficient treatment for morbid obesity and reduces obesity-related co-morbidities. With the growing number of patients undergoing gastric bypass, complications now demand further attention. Postprandial hyperinsulinemic hypoglycemia (PHH) after Roux-en-Y gastric bypass is a complex condition, characterized by increased glucose variability including both hyperglycemic (...) and glucagon-like peptide-1 responses compared to asymptomatic operated patients. The counter-regulatory mechanisms responsible for preventing hypoglycemia appear to be altered. The cause of these changes is not entirely understood, and it remains difficult to identify patients at risk of developing hypoglycemia. Known risk factors are female sex, longer time since surgery, and lack of prior diabetes. Management of the hypoglycemic episodes is difficult, and only dietary modifications consisting

2016 Surgery for Obesity and Related Diseases

16. Risk factors for spontaneously self-reported postprandial hypoglycemia after bariatric surgery. (PubMed)

Risk factors for spontaneously self-reported postprandial hypoglycemia after bariatric surgery. Postprandial hypoglycemia (PPHG) is a recognized complication of Roux-en-Y gastric bypass (RYGB) surgery. Data on PPHG after laparoscopic sleeve gastrectomy (LSG) are scant.The objective of the study was to identify preoperative predictors of PPHG in subjects spontaneously self-reporting PPHG after RYGB or LSG. Patients, Setting, and Intervention: Nondiabetic patients spontaneously self-reporting (...) symptoms/signs of PPHG (PPHG group, 21 RYGB and 11 LSG) were compared in a case-control design with subjects who never experienced spontaneous or oral glucose tolerance test (OGTT)-induced hypoglycemia over 24 months after surgery (No-PPHG group, 13 RYGB and 40 LSG). Paired pre- and postoperative 3-hour OGTTs were analyzed in all participants.Insulin sensitivity was assessed by the oral glucose insulin sensitivity index and β-cell function by mathematical modeling of the C-peptide response

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2016 Journal of Clinical Endocrinology and Metabolism

17. Postprandial Hypoglycemia

Postprandial Hypoglycemia Postprandial Hypoglycemia Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Postprandial Hypoglycemia (...) Postprandial Hypoglycemia Aka: Postprandial Hypoglycemia , Reactive Hypoglycemia From Related Chapters II. Causes Post-surgical conditions with rapid gastric emptying Gastrectomy Pyloroplasty Vagotomy Fructose Intolerance Leucine sensitivity III. Pathophysiology Excessive following rapid absorption Results from post-surgical rapid gastric emptying IV. Management See Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Postprandial

2018 FP Notebook

18. Incidence and Predictive Factors of Postprandial Hyperinsulinemic Hypoglycemia After Roux-en-Y Gastric Bypass: A Five year Longitudinal Study. (PubMed)

Incidence and Predictive Factors of Postprandial Hyperinsulinemic Hypoglycemia After Roux-en-Y Gastric Bypass: A Five year Longitudinal Study. Postprandial hyperinsulinemic hypoglycemia (PHH) is often reported after Roux-en-Y gastric bypass (RYGB). In the absence of a prospective study, the clinical and biological determinants of PHH remain unclear.To determine the incidence and predictive factors of PHH after RYGB.Participants were 957 RYGB patients enrolled in an ongoing longitudinal cohort

2016 Annals of Surgery

19. No Islet Cell Hyperfunction, but Altered Gut-Islet Regulation and Postprandial Hypoglycemia in Glucose-Tolerant Patients 3 Years After Gastric Bypass Surgery. (PubMed)

No Islet Cell Hyperfunction, but Altered Gut-Islet Regulation and Postprandial Hypoglycemia in Glucose-Tolerant Patients 3 Years After Gastric Bypass Surgery. Postprandial hyperinsulinemia characterizes Roux-en-Y gastric bypass (RYGB) and sometimes leads to reactive hypoglycemia. We prospectively evaluated changes in beta cell function in seven RYGB-operated patients with a median follow-up of 2.9 years with hyperglycemic clamps and oral glucose tolerance tests (OGTTs). Three years after RYGB (...) risk of postprandial hyperinsulinemic hypoglycemia.

2016 Obesity Surgery

20. Bolus Calculator Reduces Hypoglycemia in the Short Term and Fear of Hypoglycemia in the Long Term in Subjects with Type 1 Diabetes (CBMDI Study) (PubMed)

, could further improve metabolic control and related psychological issues.After the previous clinical trial, in which the subjects were randomized either to treatment with the calculator or to control group for 4 months, both groups used the calculator during an additional 4-month period.In the previous control group, after using the device, HbA1c did not improve (7.86% ± 0.87% vs. 8.01% ± 0.93%, P 0.215), although a significant decrease in postprandial hypoglycemia was observed (2.3 ± 2 vs. 1.1 (...) Bolus Calculator Reduces Hypoglycemia in the Short Term and Fear of Hypoglycemia in the Long Term in Subjects with Type 1 Diabetes (CBMDI Study) In a previous study we demonstrated improvement in metabolic control and reduction in hypoglycemia in people with type 1 diabetes on multiple daily injections, after having used a bolus calculator for 4 months.To demonstrate whether (1) extending its use (2) or introducing it in the control group, previously subjected to treatment intensification

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2017 Diabetes technology & therapeutics

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