In a controlled study of 45 patients in San Francisco, California, hypoglycemic episodes seemed common while primarily unnoticed.
A three-day monitoring period of regular activity showed that symptomatic hypoglycemia appeared in 22% of 15 individuals following gastric bypass surgery. Additionally, 20% of 15 individuals who underwent biliopancreatic diversion with duodenal switch showed symptomatic hypoglycemia. Out of the 15 obese patients that did not go through a weight loss surgery, none of them had symptomatic hypoglycemia. These non-symptomatic patients were non-diabetic and were a match to the surgical patients in their body mass index (BMI).
The patients in both groups showing symptoms spent a large amount of time in hypoglycemia, according to Dr. Niclas Abrahamsson and associates when reporting to the American Diabetes Association annual scientific session.
Patients following gastric bypass spent an average of 42 minutes each day holding glucose levels that were lower than 3.3 mmol/L. Additionally, the patients spent 21 minutes each day with levels that were lower than 2.8 mmol/L. Patients coming out of duodenal switch surgery had an average of 85 minutes each day with glucose levels that came it at 3.3 mmol/L as well as an average 39 minutes each day at levels of lower than 2.8 mmol/L. The obese patients not undergoing surgery (the control group), did not have any glucose levels as low.
Dr. Abrahamsson stated that it was surprising to see the number of hypoglycemic episodes given that the control group had no episodes. The patients being monitored where 80% unaware of these hypoglycemic episodes. Dr. Abrahamsson pointed out that the clinical significance of the findings should be that there should be alertness to possible hypoglycemia symptoms following weight loss surgery.
Monitoring showed that the individuals having undergone duodenal switch surgery had the lowest mean glucose level at 4.6 mmol/L and lowest mean hemoglobin level at 29 mmol/mol. The patients have come out of gastric bypass surgery had a mean glucose level of 5.3 mmol/L and hemoglobin levels of 36 mmol/mol. While the control group having no surgical procedure came in with a mean glucose level of 5.9 mmol/L and hemoglobin levels of 38 mmol/mol.
The glucose readings on the patients with gastric bypass surgery over a continuous period were more variable than those patients having gone through duodenal switch surgery. The difference is likely due to the glucose absorption abilities of the body after the different types of surgery. With the different types of surgery, there is to be a difference in how much the body will absorb because of the rerouting of the stomach.
These dramatic numbers are somewhat alarming to many in the medical community. It warrants careful observation of patients following gastric bypass surgery and duodenal switch for symptoms of hypoglycemia. When left untreated hypoglycemia can result in cognitive changes, brain function difficulty and motor function changes in patients. This said, monitoring patients individually on a long-term continuous basis is not really a practical measure, according to Dr. Thomas Barber of the University of Warwick, England. Additionally, blood glucose testing only takes a quick look at the levels at any given time. This leaves the possibility of missing measurements that don’t occur all of the time.
It is believed that the results of these studies will affect how many physicians advise their patients and how they manage their care after surgery. Alarming numbers like the data on the research makes it easy to see how prevalent the issue is. The issue is certainly one that will require further research and added care on the part of the medical community and how they handle patients in need of weight loss surgery.