Article Figures & Data
Figures
- FIGURE 1
Assessment and treatment of postprandial post-gastric bypass hypoglycemia (PGBH). See Figure 2 for assessment and treatment of fasting PGBH.
- FIGURE 2
Assessment and treatment of fasting post-gastric bypass hypoglycemia (PGBH). See Figure 1 for assessment and treatment of postprandial pgbh.
Tables
- TABLE 1
Differential diagnosis for hyperinsulinemic hypoglycemia after gastric bypass surgery
Endogenous causes Insulinoma Early or late dumping syndrome Post-gastric bypass hypoglycemia Exogenous causes Insulin secretagogue use (sulfonylureas, meglitinides) Exogenous insulin administration - TABLE 2
Biochemical patterns and timing of hypoglycemia seen with endogenous and exogenous causes of hypoglycemia
Feature Endogenous causes Exogenous causes Insulinoma Late dumping syndrome PGBH Insulin secretagogues Exogenous insulin Glucose < 55 mg/dL < 55 mg/dL < 55 mg/dL < 55 mg/dL < 55 mg/dL Insulin Increased Increased Increased Increased Increased C-peptide Increased Increased Increased Increased Decreased Sulfonylurea/meglitinide screen Negative Negative Negative Positive Negative Timing of hypoglycemia Fasting Postprandial Postprandial After ingestion After injection PGBH = post-gastric bypass hypoglycemia
Eat 3 meals daily without skipping meals. Portions should be ¼ to ½ cup per meal but may gradually increase. Stop eating as soon as you feel full. Eat only nutrient-dense food. Avoid foods high in sugar and fat. Read labels carefully! The goal is less than 3 or 4 grams of sugar per meal. For every 100 calories, there should be no more than 3 grams of fat. Protein intake once patients reach a healthy weight is typically 0.8 to 1 g/kg per day, averaging 60 to 80 grams per day. Include protein with every meal. Protein powder or nonfat dried milk can be added to foods to boost protein content. Consume 60 to 80 grams of protein each day. Limit fat. For every 100 calories consumed there should be no more than 3 grams of fat. Eat slowly, 1 bite every 2 minutes. Use a stopwatch or an egg timer to pace yourself. Chew! Chew! Chew! Foods should be chewed until they are the consistency of applesauce. Advance your diet slowly and introduce new foods in small amounts. No fluids with meals. Avoid drinking liquids 15 minutes before meals and 30 to 60 minutes after meals. Drink at least 64 ounces of decaffeinated fluids daily. Avoid alcohol. It is dehydrating and adds calories with no nutrients. Based on Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis 2013; 9:159-191.
