July 22, 2016

Gastric-Bypass Creates Hypoglycemia Problems

If you are concerned about hypoglycemia, then this article should scare the dickens out of you. The title grabbed my attention - Gastric Bypass Reduces Symptoms, Hormonal Responses to Hypoglycemia. In other words, after gastric bypass surgery, you will have even fewer symptoms and other responses to hypoglycemia, i.e., you will be operating more in the blind and may not have any knowledge you are having hypoglycemia.

Gastric bypass surgery patients have lowered glucose levels and frequent asymptomatic hypoglycemic episodes, Niclas Abrahamsson, MD, PhD, from Uppsala University in Sweden, and colleagues examined symptoms and hormonal and autonomic nerve responses in patients exposed to hypoglycemia before and after gastric bypass. Twelve obese patients without diabetes underwent hyperinsulinemic hypoglycemic clamp before and after gastric bypass surgery.

The researchers found that after surgery the Edinburgh Hypoglycemia symptom delta scores during clamp were attenuated from 10.7 to 5.2. Marked reductions in glucagon, cortisol, catecholamine, and sympathetic nerve responses to hypoglycemia were seen after surgery. A delayed response was seen in growth hormones, but to a higher peak level. During hypoglycemia, glucagon-like peptide-1 and gastric inhibitory peptide increased, but to a lesser extent after surgery.

Catecholamine is any of a group of sympathomimetic amines (including dopamine, epinephrine, and norepinephrine), the aromatic portion of whose molecule is catechol.

Gastric bypass surgery causes a resetting of glucose homeostasis, which reduces symptoms and neurohormonal responses to hypoglycemia, the researchers wrote. Further studies should address the underlying mechanisms as well as their impact on the overall metabolic effects of gastric bypass surgery.

All this leads to problems for people with diabetes that do not recognize when they are having an episode of hypoglycemia and possibly means that they could go into a coma and die. Not a pleasant outlook for these people. Yet this is not something that the bariatric surgeons will pass on the prospective patients.

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