Bariatric Surgery- Unstable Blood Sugar After Gastric Bypass
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Many would say the benefits of weight loss surgery are obvious. You look better, you feel better, you’re healthier, and you live longer. There are many common side effects of surgery, which clients obviously must decide for themselves if the potential benefits are worth the risks and inconveniences. There is an emerging trend however of a much more serious complication of unstable blood sugar.
Gastric Bypass
Bariatric Surgery Benefits and Risks
Bariatric surgery is a general term referring to weight loss surgery. Approximately 160,000 Americans have gastric bypass weight loss surgery each year. Generally candidates must be at least 100 lbs overweight, and go through rigorous testing and counseling before surgery. The most common surgery is the Roux-en-Y. Of course there are risks with any surgery, and the decision to have bariatric surgery cannot be taken lightly. The benefits must outweigh the risks. What are the benefits and risks?
A significant proportion of prospective clients already have weight-related chronic health problems such as high blood pressure, sleep apnea and diabetes. Many bariatric candidates and their physicians consider the surgery a matter of life and death. Other candidates are surely at risk to develop these and other obesity-related problems that are known to negatively impact good health and quality of life.
There are risks of complications related directly to the surgery, such as bleeding and leakage around the surgical site. There is an array of side effects after surgery, many of which are permanent. Among these are multiple vitamin and nutritional deficiencies and something called dumping syndrome. Dumping occurs when undigested food passes too quickly from the now egg-sized stomach into the small intestine. Symptoms, which can include feeling faint or dizzy, tend to happen after a high carbohydrate meal.
Reactive Hypoglycemia
A condition is emerging in a small percentage of clients, occurring 2 to 5 years after bariatric surgery. The condition, associated primarily with the Roux-en-Y procedure, is a potentially dangerous drop in blood sugar, called hypoglycemia. The symptoms occur after meals and include feeling confused or light headed, having a fast pulse, sweating, and shaking. Because these symptoms are similar to dumping symptoms, many clients are not given a proper workup for blood sugar regulation abnormalities. One factor that distinguishes hypoglycemia in these clients is blacking out, and in some cases causing car accidents. Clients may also report feeling ravenous, having bad morning headaches, or having nightmares.
In 2005, the president of the American Society for Bariatric Surgery, Dr. Neil Hutcher, stated he had not seen the severe low blood sugar complication, neuroglycopenia, in his 3000 bariatric operations. Other experts at that time proclaimed the problem was rare, corrected by surgical removal of all or part of the pancreas, and that patients had no further complications. They therefore concluded it was unnecessary to curtail bariatric procedures.
Also in this timeframe, by contrast major hospitals and universities were publishing studies of small numbers of clients with reactive hypoglycemia. Clients were experiencing these dramatic severe drops in blood sugar after meals. Episodes began several years after successful weight loss from bariatric surgery. Considered a delayed or latent effect of dumping syndrome, undigested food quickly passes from the stomach pouch to the small bowel. Excessive insulin is then released, resulting in the rapid and dramatic drop in blood sugar, and onset of symptoms including confusion or passing out.
Removal of Pancreatic Tissue for Hypoglycemia After Bypass Surgery
Also in 2005, an important study was released in October by a collaborative group of researchers from Joslin Diabetes Center, Brigham and Women’s Hospital and Beth Isreal. The researchers noted that, while rare, the blood sugar should be evaluated expeditiously in clients exhibiting symptoms. The severe drop in blood sugar is potentially dangerous and the researchers were concerned that they would be attributed to dumping and essentially ignored. It is easy to imagine that many cases may go undiagnosed if they occur 5 years after gastric bypass surgery. By this time, the client may no longer be following up with the bariatric team. Clients and personal physicians may likely attribute symptoms to dumping.
The research team studied three clients who experienced severe hypoglycemic episodes after meals. Two clients caused auto accidents. These clients did not respond to dietary changes or medicines. Their symptoms got worse over time. They all subsequently had all or part of their pancreas removed, which was the emerging treatment for this condition. Examination of the removed tissue revealed an increase above normal in the number insulin producing cells.
Most studies concluded clients seemed to experience decreased severity of symptoms due to drops in blood sugar following removal of pancreatic tissue. For some clients however, the condition recurred.
Carnie Wilson
Poor Glucose Regluation Associated with Weight Gain After Bypass
In 2009 at the American Society for Metabolic & Bariatric Surgery Meeting, Dr. Mitchell Roslin of Lenox Hill Hospital, NY reported another tend of blood glucose issues. He noted common presentations by clients who regained weight after gastric bypass. Patients were understandably alarmed, and reported an uncontrollable drive to eat shortly after meals. Although less dramatic, again a reactive hypoglycemia was suspected. They theorized mildly decreased blood sugar levels due to increased insulin release would increase hunger.
Dr. Roslin and associates studied 67 clients, with an average of four years since gastric bypass surgery. The average age was 48, with 81% female. Average weight pre-surgery was 300 lbs, with an average body mass index (BMI) of 49. (Healthy BMI is 18.5 to 25.) Clients lost an average of 55% BMI of their excess weight. Clients had regained an average of 26 lbs. After glucose tolerance testing, 80% were determined to have glucose abnormalities.
The specialists found the most dramatic swings in blood glucose were associated with small stomach pouches with wide anastomoses. They concluded that alternatives to the standard gastric bypass procedure, such as incorporation of valves needed to be explored. Further, they suggested that gastric bypass be abandoned, and a completely different approach be explored. Bombshell!
This article is dedicated to Miss Betty, Peter and Amy.
Gastric Bypass Benefits in the News
- Gastric banding more effective than lifestyle changes for severely obese teens, study findsLos Angeles Times5 hours ago
With the success of gastric bypass surgery, some doctors hope the FDA will approve use of the band device for adolescents. Gastric banding surgery appears to be significantly more effective than lifestyle interventions in helping severely obese teenagers lose a significant amount of weight and keep it off, a new study suggests.
- Turia still pushing for Govt funded stomach stapling3news21 hours ago
It has been nearly three months since Tariana Turia underwent a gastric bypass.
- Weight-Loss Surgery May Help Severely Obese Teens (Correct)Bloomberg6 hours ago
(Corrects revenue figure in sixth paragraph.) Feb. 10 (Bloomberg) -- Weight-loss surgery was more effective at slimming severely obese teens and improving their health than two years of diet and exercise, a study found.
Gastric Bypass Side Effects
- Gastric banding surgery offers fewer complications, but more research neededNews-Medical-Net19 hours ago
Laparoscopic adjustable gastric banding surgery can effectively treat obesity in adolescents and seems to offer a better alternative than gastric bypass surgery, but further study is needed to determine whether it's better than nonsurgical options, a UT Southwestern Medical Center surgeon writes in an editorial in the Feb. 10 issue of the Journal of the American Medical Association.
- A Nation at Large:Local man prepares for gastric bypass procedureThe Marietta Times2 days ago
Although weight has been a problem at times for Oak Grove resident David Offenberger, it hasn't always been such an issue. Offenberger, 53, and a shade under 400 pounds, said there was a time when he could lose 50 pounds or more with little effort. "The difference today is that I have health problems that prevents me from doing the things I need to do to burn off those calories," he said.
- Questions remain on bariatric surgery for adolescentsEurekAlert!7 hours ago
( UT Southwestern Medical Center ) Laparoscopic adjustable gastric banding surgery can effectively treat obesity in adolescents and seems to offer a better alternative than gastric bypass surgery, but further study is needed to determine whether it's better than nonsurgical options, a UT Southwestern Medical Center surgeon writes.
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Comments
Great hub, Rosemary! I'm curious about the pancreatic surgery to reduce hypoglycemic episodes. Can/does that lead to diabetes eventually?
Thanks for the kudos girls!
@AW, click on the link near the end. The researchers recommended vertical-sleeve gastrectomy and duodenal switches, whatever that all means. Of course that would be new territory. Will there be equal or worse problems from that procedure down the line? It did seem this problem was almost exclusive to the roux n Y. At any rate, absolute best of luck with your surgery.
@Lisa, they do fear that clients will possibly develop diabetes. The whole thing sounds rash doesn’t it? I know someone this happened to. They removed half of her pancreas and she still had these pass-out drops in blood sugar. She fell and broke her wrist and had the longest wrist MRI report I had ever seen. Likely because osteoporosis is worsened by bypass too I think.
I will be going back and adding links for more of my sources, but wanted to squeak this in before the new HubMob topic launches tomorrow.
RM
With a diabetic daughter that suffered from severe hypoglycemia for years and a granddaughter just recuperating from Congenital Hyperinsulinism, I'm really curious as to cause of this hypoglycemia. Would you consider delving into that a bit more on another hub?
For you lrohner, I’ll consider it. It would be much easier however to tackle any “medical” topic once I’m back at WHMC volunteering, because I’ll have access to the online medical library.
From what I know at this point:
Long before surgery, the body adapts to try to keep up with the insulin demands. Think of a healthy sized body as a quart container. There is an amount of insulin that is optimal for function for 1 quart. At 2 quarts, the body may be able to increase production to have enough insulin. Person may not yet be diabetic. At this point, the pancreas actually has an increased number of islet cells (the insulin producing cells of the pancreas). As a person becomes more obese, there is a point at which the body can’t keep up, they will be diabetic, but still have “extra” islet cells that a healthy weight person wouldn’t have.
Bariatric surgery is thought to “cure” diabetes for most clients, in part because of the insulin response. Experts think that for most people after gastric bypass, the body reverses the process with the islet cells in the pancreas. The number of islet cells decreases. For those that develop this “reactive hypoglycemia”, the pancreas keeps these extra cells, therefore has too many. When they eat, especially a high carb meal, they have 2 quarts-equivalent of insulin, but now their container is only 1 quart-sized.
So, another hub later? Or does this answer the question, in which case I’ll polish a bit more and include it in this hub. Once back at WHMC, I’m going to look up “Miss Betty” and hopefully interview her for another hub. She said her surgeon told her this may be happening in 20% of bypass clients. Wonder what Dr. Hutcher has to say about that.
good hub
I considered having this a couple of years ago. I've gained a lot of weight since I developed health problems and am not very active anymore. My doctors told me NOT to have the weight-loss surgery because of my bouts with anemia. Sometimes my hemoglobin drops to 7, even with taking vitamins with iron plus liquid iron (yuck). I have a friend who had this surgery, and he's done wonderfully!
habee my health was going down the tubes too until I made the switch to alternative medicine. I used to be on iron, potassium and B-12 shots, and 11 prescription and OTC meds. I have one friend who had the surgery and has done well so far, and one who is the reason I know about this problem.
Photo Credits
- SHARON OSBORNE on Flickr - Photo Sharing!
- Diabetes365 Day 55 - 120407 on Flickr - Photo Sharing!
- 101_0765 on Flickr - Photo Sharing!
- Carnie Wilson Before & After Gastric Bypass on Flickr - Photo Sharing!
- Stomach Bypass on Flickr - Photo Sharing!
Quick and simple diagram on how stomach stapling works. - roux_en_y on Flickr - Photo Sharing!
- roux-en-y_gastric_bypass on Flickr - Photo Sharing!
- Anatomy of pancreas on Flickr - Photo Sharing!
Anatomy of pancreas







atomswifey says:
5 months ago
WOW great hub here!
The surgery I have opted for is not the full gastrric bypass. It is the insertion of the lap band which is not exactly the same thing, but I will talk to my doctor about all of this my next appointment prior to surgery.
Thank you for all this information!
:)