...is inhaling a bowl of Kashi and soy milk because she crashed! hard on chicken nuggets? At least, that's the last thing I remember eating. Five. Perdue. Chicken. Nuggets. I found myself crashing, literally, into the couch and turning the DVR on to the fucking Disney Christmas Parade. That meant trouble. My glucose strip container was empty, so I just guessed that I was very low -- treated it with Kashi. I'm back. But, that was unexpected!

Artificial Sweeteners May Help Control Blood Sugar?

SOURCE: Diabetes Care, December 2009.

NEW YORK (Reuters Health) - Combining artificial sweeteners with the real thing boosts the stomach's secretion of a hormone that makes people feel full and helps control blood sugar, new research shows.

It's unknown whether this means anything for people's health, but "in light of the large number of individuals using artificial sweeteners on a daily basis, it appears essential to carefully investigate the associated effects on metabolism and weight," conclude Dr. Rebecca J. Brown and colleagues from the National Institute of Diabetes and Digestive and Kidney Diseases.

Because artificial sweeteners are virtually carbohydrate-free, they have been thought not to have any effect on how the body handles glucose (sugar), the researchers explain.

But there's some evidence that artificial sweeteners may trigger secretion of glucagon-like peptide-1 (GLP-1). GLP-1 is released from the digestive tract when a person eats as a "fullness" signal to the brain, curbing appetite and calorie intake.

To investigate further, Brown's team had 22 healthy normal-weight young people take two glucose challenge tests. These tests, which measure how well the body metabolizes glucose, require a person to drink a sugar-filled beverage after fasting for several hours.

Ten minutes before consuming the "glucose load," study participants drank either roughly two-thirds of a diet soda containing an artificial sweetener or the same amount of carbonated water.

In both cases, the increase in a person's blood glucose was the same. But the researchers did find that people secreted significantly more GLP-1 when they drank diet soda before the glucose challenge compared to when they drank carbonated water.

Studies in humans and animals have shown that when artificial sweeteners are consumed without carbohydrates they do not trigger GLP-1 secretion. "However, our data demonstrate that artificial sweeteners synergize with glucose to enhance GLP-1 release in healthy volunteers," Brown and colleagues report.

What this all means to the average diet soda drinker is not known, but the fact that the effect occurred with less than a single can of diet soda suggests it "may be relevant in daily life," the researchers say.

Future research is needed to understand the significance of enhanced GLP-1 secretion for health, they conclude, and studies should be conducted in people with type 2 diabetes and other abnormalities in metabolism.

* * *

Thank you Medtronic.

Medtronic continued to attempt to get insurance coverage for my replacement sensor-thingamajig after I gave up on it.  The doc had told me, "not until you make a new appointment with me."  They got me via email and phone, and it will be here Monday.  Thank you Medtronic!  Now, to find the box with the CGMS in it, since I had you know, written it off.  :x

Thinking about revision

I'm in the early stages of considering revision surgery. 

As the head spins.

I was just cleaning up downstairs when I felt goofy and got that "Uh oh, time to go sit down" feeling.  

For fun, I tested my blood sugar.  Fumbling with the meter, as always.

Low.  Um, DUH? 

THIS IS THE WAY YOU FEEL EVERY TIME YOU ARE CRASHING, TOO!  It's just to confuse you!  Seizure or low, what could it be?

Tiny tattoos could help diabetics ditch needles

As a hypoglycemic with blood sugar drops all day long  (just believe me, it does) who does NOT check her blood sugar anywhere near as much as she SHOULD -- I would jump at the chance to use an alternative method of testing my glucose levels.

This is cool:

Help may be on its way for Balobeck and other diabetics who must jab themselves as many as 10 times each day to get that critical drop of blood that will reveal glucose levels and indicate whether a shot of insulin is needed.

Scientists are starting to test a kind of sensor that changes color with rising blood sugar levels. The high-tech tattoo, which is about the size of the clicker on the end of a ballpoint pen, is made up of tiny spheres that are injected into the outermost layer of skin. These nanospheres contain a special kind of ink that reacts with glucose, explains the tattoo’s inventor, Heather Clark, a biomedical engineer at Draper Laboratory in Cambridge, Mass.

Although the tattoo hasn’t yet been tested in humans, the early results in mice have been very promising, Clark says.

The new sensor may be more like a mood ring than a tattoo since it reflects changes in a person’s skin. As it turns out, when blood sugar levels rise, glucose levels increase everywhere else in the body, from the eyes, to the kidneys — even to the outermost layer of the skin.

Each tattoo sensor is made up of millions of tiny rubbery beads that can be injected into the skin like the dye that makes up a regular tattoo. The beads are so small that 600 of them placed end to end could fit across the diameter of a hair.

The tiny beads are infused with two substances. One is a molecule that can pull glucose into the sphere and bind to it. The other is a special fluorescent dye. With no sugar present, the two molecules bind to each other and turn the sphere yellow. When sugar levels rise in the skin, molecules with glucose attached jettison the dye and the sphere turns purple. 

Exactly what color you see in the tattoo will depend on how much glucose is available to be grabbed out of the skin, Clark explains. A healthy level leaves the tattoo with a kind of orangey color.

In mouse experiments, the tattoo color has tracked well with blood samples, Clark says.

The next step is to try the tattoo out on diabetic mice and if that works out, the researchers will be ready to test the tattoo in people. Clark isn’t sure when that will happen, but she’s hoping it will be within the next five years.

If the research pans out, it would be a welcome change for both patients and the doctors who treat them. Even if the tattoo turned out to be a little less accurate than the blood sugar test, it would be a big help, says Dr. Rexford Ahima, an associate professor of medicine at the Institute for Diabetes, Obesity and Metabolism at the University of Pennsylvania.

“If there was a painless way to allow us to monitor blood sugar, that might encourage more people to stick with their treatment,” he said.

Julia Balobeck has her fingers crossed. “I just had my birthday and at my party I had to test my blood sugar five times,” she says. “It would make my life a ton better if I didn’t have to prick my fingers anymore.”

Linda Carroll is a health and science writer living in New Jersey. Her work has appeared in The New York Times, Newsday, Health magazine and SmartMoney.

URL: http://www.msnbc.msn.com/id/33831728/ns/health-diabetes/

Reading Nutritional Labels for Diabetics - Understanding Carbohydrates

Reading Nutritional Labels for Diabetics -- powered by http://www.livestrong.com

Effect of caffeine on the recognition of and responses to hypoglycemia in humans

Effect of caffeine on the recognition of and responses to hypoglycemia in humans.

FLUFFERNUTTER!!

Those of you out there that are digestively redesigned with a partner/spouse who is NOT digestively altered -- and maybe has a weight problem, is obese or just plain eats like crap and has a super metabolism -- WHAT DO YOU DO?  For someone that hasn't had their internals screwed with, they can EAT.  A lot, in quantity and badly!  What do you do if their habits do ot change when you go under the knife?  Do you bitch, moan and complain?  Do you nag until they stop?  (Or at least stop eating around you?)  Do you accept it and just happily eat your leans and greens while they indulge in sweet, fatty delights? (Shut up DS'ers.)

Is please to thank you for not giving trouble in the comments.  I share because, I can and it's reality.  You should know that I have avoiding sharing lots of things because of catty comments.  So.  Be nice.

For my diabetic readers or hyper hypos like me

Entra Health Systems out of San Diego, CA has been rolling out its Bluetooth powered glucose meter which can synchronize data with a computer or other devices. The firm has just announced that the MyGlucoHealth system, with which the company's meter interacts, can now send updates of patient's historical glucose trends, as well as reminders to check glucose or stock up on more strips.

Gestational Diabetes Screening in a Bariatric Patient

You're pregnant, and you have also had a gastric bypass. 

You are terrified of taking the gestational diabetes screening, because it's typically done with a 50-sugar-gram sickly sweet syrup, Glucola. 

"It's going to make me dump!  OMG!"

 

And, it might.  It's a highly concentrated dumping potion, and you don't HAVE TO have it done.  Say no.

Of course your OB/GYN or midwife MUST KNOW that you're a gastric bypass post op, and there ARE OPTIONS aside from the obvious.  Ask for them.  You may have to educate the doctor.

From:  Management and Outcomes of Pregnancy following Bariatric Surgery

Prenatal Screening Tests in Bariatric Surgical Patients
Screening for gestational diabetes is recommended in all pregnancies; however, post-GBP patients may be unable to tolerate either the classic 50-gram glucose challenge or the 100-gram oral glucose tolerance test due to dumping syndrome.

Dumping syndrome occurs because rapid gastric emptying of hyperosmolar contents directly into the small bowel after GBP leads to fluid shifts into the bowel lumen, resulting in distention.19 In early dumping syndrome, patients present with abdominal cramping, bloating, nausea, vomiting, and diarrhea. Later, a subsequent release of excessive insulin causes subsequent hypoglycemia. Therefore, late dumping syndrome patients present with tachycardia, palpitations, agitation, and diaphoresis.

Landsberger, et al., suggested using modified glucose testing.

They recommend obtaining a fasting blood glucose level and a two-hour postprandial level after consuming the most carbohydrate-loaded breakfast the patient can tolerate.

If fasting and two-hour postprandial glucose levels are less than 95mg/dL and 120mg/dL respectively, they are considered normal. Landsberger also recommends following hemoglobin, hematocrit, serum iron, ferritin, erythrocyte folate, methylmalonic acid, albumin, prealbumin, serum calcium, phosphate, and 25-hydroxy vitamin D levels. They assert that erythrocyte folate is a better indicator of true deficiency, whereas serum folate merely reflects recent oral intake, and that methylmalonic acid is more sensitive in detecting vitamin B12 deficiency. Finally, Wax, et al., recommend that second trimester maternal serum a-fetoprotein and ultrasound screening be offered, even if current data reflects that the risk of NTDs is theoretical.21

But, a pregnancy without the danger of gestational diabetes is worth it. You may find that even if you had it in a previous pregnancy -- since WLS it might not occur.

Gastric Bypass Linked to Abnormal Glucose Tolerance

As a person who has been living like this for what, three to four years, this goes in the "OBVIOUSLY docs, haven't you been listening?!" file.  I am so glad it's being taken seriously.

From the ASMBS Conference:

Patients who undergo gastric bypass surgery often have undiagnosed glucose abnormalities that can lead to bad eating habits and regained weight, a small clinical study suggests.

Almost 80% of the patients had glucose abnormalities, including hyperglycemia, hypoglycemia, or both, Mitchell Roslin, MD, of Lenox Hill Hospital in New York, reported here at the American Society of Metabolic and Bariatric Surgery meeting.

Patients were alarmed by the weight regain, but at the same time, they often had a ravenous appetite soon after a meal, accompanied by an almost uncontrollable urge to eat.

"Our hypothesis is that . . . patients may have an enhanced insulin response," said Dr. Roslin. "They have rapid emptying of the pouch that leads to reactive hypoglycemia. The combination of an empty pouch and low blood sugar leads to hunger."

The findings have led him to question whether gastric bypass surgery should remain the gold standard procedure for treating obesity, he added. At the very least, surgeons should consider the possible need to include a valve in gastric bypass.

The findings have led him to question whether gastric bypass surgery should remain the gold standard procedure for treating obesity, he added. At the very least, surgeons should consider the possible need to include a valve in gastric bypass.

The study evolved from clinical observations during patients' periodic postoperative visits. A growing number of patients complained of weight regain and loss of restriction. The complaints often had a common ring.

"Patients were saying that one or two hours after eating, they were ravenously hungry," said Dr. Roslin. "It sounded a lot like hypoglycemia to me."

To investigate the origin of the symptoms, Dr. Roslin and colleagues studied 63 patients who had undergone gastric bypass procedures. All the patients had a 100-g glucose tolerance test, wherein the maximum/minimum glucose ratio was assessed one to two hours after the glucose challenge.

The investigators defined reactive hypoglycemia as a glucose value <60 mg/dL, or a decrease of 100 mg/dL or more within two hours and no glucose value exceeding 200 mg/dL. They defined hyperglycemia as any value >200 mg/dL and no value <80 mg/dL. Follow-up from surgery averaged about four years. The mean age of the group was 48.5, and 81% were women. The patients' average preoperative weight was 138 kg, with an average body mass index of 49. One-third had preoperative diabetes. The percentage of excess BMI lost averaged 55%, and the patients had regained an average of 12 kg.

Glucose tolerance tests showed six patients with hyperglycemia, including five who had normal fasting blood glucose levels. In addition, 35 patients had reactive hypoglycemia, while eight had hyper- and hypoglycemia.

"The hyperglycemic cohort was characterized by a rapid rise to high sugar levels," said Dr. Roslin. "The fact that most of these patients had normal fasting glucose means we need to be very careful of what we call cure or control of diabetes."

Reactive hypoglycemia manifested as a rapid upsurge of glucose levels that correlated with a rise in insulin and then a rapid decline during the second hour after the glucose challenge.

Patients with both hyper- and hypoglycemia had even more pronounced swings in glucose and insulin levels, said Dr. Roslin.

The most dramatic rises and falls in blood glucose have been associated with small pouches and wide anastomoses, he added.

The findings suggest a need to consider alterations in the standard gastric bypass procedure, such as use of valves, or possibly abandonment of the procedure in favor of another approach.

"I believe that vertical-sleeve gastrectomy and duodenal switches that are not severely malabsorptive will be the best options in the future," said Dr. Roslin.

Driving under the influence of poor blood sugar control, diabetes and reactive hypoglycemia.

I've nevereverever even had diabetes, but dealing with reactive hypoglycemia is sometimes like having diabetes, some of the crappy parts.

From the Mayo Clinic, an entry regarding:

Driving with diabetes

I am nearly ready to start driving again, (I was on a six month wait for seizure control) but I am determined to MAKE FOR DAMN SURE my blood sugars (in addition to my brain explosions) are controlled before I get behind that wheel with my kids.  Most of the time, I cannot predict a hypoglycemic event, but I must be prepared.  I could very easily become dangerously hypoglycemic at any moment, and lose control of a car (or a lawn mower for that matter!) so trying to avoid a low is imperative. 

I've been driving during a 30 mg. blood glucose level.  That's really safe, no?  o_O  In fact medical professionals have told me that my blood sugar levels were not 'compatible with the living.'  Nice to hear while you're sitting having your blood drawn!

NO, IT IS NOT OKAY.  YOU CAN KILL PEOPLE, AND YOURSELF, DRIVING WHILST UNDER THE INFLUENCE OF SCREWED UP BLOOD SUGAR.  DON'T DO IT. 

If you're a hypo like me, you must consider yourself a 'drunk' - (carb drunk perhaps?) - and TEST YOSELF BEFORE YOU WRECK YOSELF.  (I know.)  I have heard/read too many of  'us' (post WLS hypos) driving while hypoglycemic, and they're all, "Oh well."

Too high or too low blood sugar levels are dangerous when you're behind the wheel of a car. Monitoring your blood sugar is important if you're the driver. Stress, time changes, and changes in your eating and sleeping schedule can affect your blood sugar level, so it's best to test more frequently when driving with diabetes.

Hypoglycemia is an abnormally low blood sugar level typically less than 70 milligrams per deciliter or 3.9 millimoles per liter. Early symptoms of low glucose include shakiness, dizziness, hunger, headache, lightheadedness, moodiness, pallor, and confusion. As blood glucose levels continue to drop, loss of consciousness and seizures may result. Some people aren't aware that their blood glucose is dropping. This is a condition known as hypoglycemia unawareness.

Hyperglycemia is an abnormally high blood sugar level of 180 mg/dL (10 mmol/L) or greater. Symptoms of hyperglycemia that you may notice while driving include blurred vision, fatigue, hunger, excessive thirst, and frequent urination. Symptoms and effects of hyperglycemia may not be noticeable until blood sugars are above 250 mg/dL (13.9 mmol/L).

If your blood sugar is too low or too high you may not be able to focus on driving or control your car.

Some tips for driving with diabetes:

• Always test your blood sugar before driving.
• If the value is below 100 mg/dL (5.6 mmol/L) don't drive. Eat and retest and drive when blood sugar is above 100 mg/dL (5.6 mmol/L).  (In this case, I would NEVER drive.  I am typically 70-90 all day long until I am hypo.  So, I think this number can be a bit off.)
• Follow rule of 15 — treat blood sugar below 70 mg/dL (3.9 mmol/L) with 15 grams of fast-acting carbohydrate — and retest in 15 minutes. Test and retreat every 15 minutes until blood glucose is up in goal range.
• Always carry a source of carbohydrate in your car.
• Test blood sugar every two hours when driving long distances.
• Don't drive with impaired vision.
• Wear a diabetes medical ID.



• Insulin and some medications can cause low blood sugar. Test your blood sugar before you drive and don't drive if your blood sugar is too low. Check with your health care team as to how often you should check during the drive.
• Don't miss or delay a snack (depends on your diabetes medication program).
• It's never OK to drive with a low blood sugar. Stop the car if you experience symptoms of hypoglycemia. Check your blood sugar. Treat with fast-acting sugar tablets, juice, regular soda, or hard candy. Wait 15 minutes. Test and treat again as needed. Do not drive until your blood sugar level has reached your blood glucose range. You should eat a more substantial meal containing protein as soon as possible.
• I add:  If you have severe, continual problems with hypoglycemia, it may benefit you to have a Continuous Glucose Monitoring System.  (I have one, it's going back in this week.)  It's a gadget that looks like an insulin pump, that watches your sugar 24/7, and can be useful to predict trending sugar levels and AVOID lows.

Supplies to take with you:

• Glucose meter
• Snacks (in case meals are delayed), a fast-acting sugar such as glucose tablets, juice, regular soda, or hard candy.  (I recommend glucose GEL, because I have found when I am super low, I cannot deal with the chew-chew-chewing or sucking on candy, I need INSTANT relief.)
• I add for the hypos:  a carb/protein/fat combo to back up the glucose/sugar to maintain your sugar level afterwards  (Peanut Butter cracker pack)

Overall - it's about avoiding a problem and remembering that you must take extra care in keeping yourself and others SAFE.

Continuation.

...because later last night, Beth finds herself asking Bob to check her blood sugar, out of her foot because she's too drained to get the hell off the floor where she sat down for a minute because she was dizzy. 

I knew what the problem was, and just wanted to take a little, you know, break, on the way to eating again to fix the problem.  On the floor, first sitting cross-legged, and then laying down in the recovery position.

Please note:  Blood sugar levels in yer toes, don't match yer body, and toe puncture hurts like a mofo.  My toe's sugar level - 103.  "Get up off the floor, Beth, you're fine." 

"Okay, I'm getting...but I don't feel so 103..." slluuuuuuuuump. 

I grab the meter and check my finger's blood sugar, 49, which is what it feels like, a good 49.  Yeah, that's what I'm talking about.

"What did you eat?"

Again, probably the pattern of food, culminating in a low.  Good news?  I went to bed at 8:30-9pm because I felt like crap for the night.

HYPOGLYCEMIA CAN KISS MY ASS.

A personal story of post RNY hypoglycemia diagnosed later as Nesidioblastosis

I am sharing the following email by permission of the author, a nearly five year post op RNY who was dealing with severe post RNY hypoglycemia, who later discovered she had nesidioblastosis, a rare condition directly related to the RNY (Which MM thought she had considering my situation, but doctors have not tested or agreed about it.)

"Hi Beth, I had my RNY in October of 2005.  By the end of 2006 I had lost 180 lbs. and was out of wheelchair, diabetes was gone as was sleep apnea, and thought I was on my way to a new life.

 

In 2007 my blood sugars started to plummet after I would eat anything.  Since I was still having problems keeping food down I just attributed the low sugar to that. 

Then when a friend started keeping really good records we saw that when I ate within 2 hours my sugar would plummet to anywhere from the 20's to 40's. 

As you can imagine when I would hit the 20's I would black out and fall where I was causing lots of pain and damage.  Luckily for me, my service dog trained himself to pick up on my low sugars usually about 40 and he wouldn't leave me alone until I was on the floor.  This helped but I could no longer safely drive or work and became disabled again.

 

I went to so many Docs that my speed dial was overflowing then I read either on OSSG or the Obesity Help website about a couple other people having the same problem.  I was told my only recourse was to have the bypass reversed, that for some people their body just wouldn't accept the change.  I asked my Bypass Surgeon (who had never done, nor ever wanted to do a reversal) for some help.

 

My surgeon said she had gone to school with a Dr. who specializes in the pancreas and works at UCI medical center here in Orange CA. I contacted him and took him all the info I had put together from the internet. 

He said there was no way I could have Nesidioblastosis because it only happens in infants.  After a year of badgering and exhausting all other tests he finally agreed to do the Calcium Stimulation Test. 

When he got the results, I went in with the mind set that if he tells me "it's perfectly normal" I give up and was going to kill myself that night.  He walked in with his PA and said "I'm sorry but the test comes back in perfect range", I started to cry. 

His PA pulled him out of the room very quickly and after 5 minutes they returned.  He couldn't stop apologizing he said they have never done this test before so they didn't know that it needed to be plotted on a special graph to read the results.  His PA had caught this and once it was plotted appropriately:  I had Nesdioblastosis.

We scheduled a surgery date and then when I got home I took the dog out, my blood sugar bottomed at the top of the stairs and I fell rupturing the vertebra above and below my cervical fusion.  Since the fall had put pressure directly on my spinal cord I had to have an emergency Cervical Fusion and put off the Pancreas surgery.

The incidence of hyperinsulinemic hypoglycemia following weight loss surgery appears to be low, but since increasing numbers of weight loss operations are being performed around the world, we must be on the forefront when it comes to recognizing and treating the side effects of these life-saving operations. The exact etiology of this troublesome condition has yet to be agreed upon. More research needs to be done to clarify the causes and most effective treatment strategies for this problematic disorder.

Bariatric Times - ISSN: 1044-7946 - Volume 3 - Issue 9 - December 2006 - Pages: 1 - 12

Do I HAVE to wear one?

I am a naughty girl.  I haven't worn a medical ID in ages.  It dug into my wrist awful, and drove me crazy.  In fact, I took to hanging it on my purse, and now?  It's long gone.

Wait a minute... "Beth, do we need to wear a medical ID if we've had WLS?"  

It depends on who you ask.  Ask a surgeon or three, answers vary.  Ask a paramedic.  Ask an ER physician.  (Don't ask the nice lady who makes the bracelets, or you may be wearing two, one for your ingrown toenail issue and one for your heartburn.  Unless of course you like wearing extraneous personal information?)

Some vehemently say that it just isn't necessary, and some say you must.  

At this point, I will say, ask your personal doctors, and consider your own medical issues.  

If you do choose to go forward with an ID for WLS purposes, most WLS'ers typically use something like this:

• Your Name
• RNY Gastric Bypass 
• No NSAIDS
• No Sugar
• No Blind NG Tubes
• Emergency Contact Number 

And, some of those are debatable, ask your doc.

Otherwise -

• Your Name
• Medical Condition(s)
• Any allergies
• Emergency Contact Number 

Mine (the one I haven't worn in months and months) says - 

• Beth Sheldon-Badore
• Hypoglycemic
• Seizures
• RNY Gastric Bypass
• Emergency Contact - 
• Emergency Contact - 

No "sugar" is a non-issue, because, frankly, it could save me.  No NSAIDS isn't really an issue, because I don't think I would receive any in an ambulance.

This is a medical id necklace charm.  I love that it's different. 

I should really wear one all the time, especially when out, just in case I crash or seize.   (If I take a seat on the ground, asking for 'sugar' it might help to know that I am seriously. not. nuts.  I have no idea I am doing it.)  My medical issues frequently leave me unable to explain Just What The Hell Is Wrong With Me.

The one shown above can be found at Fiddledee IDs.

If you order a medical ID through Fiddledee ID -- you can get 10% off if you mention "Melting Mama." Why?  Because I want one, and I think these are adorable.

They also have more traditional designs, and various other products, but I was just loving the vintage fairy necklace.  ;)

• medical id bracelets
• medical id tags & charms
• medical id necklaces
• bag tags
• alert stickers & tattoos
• vintage-style charms
• sterling charms
• accessories

PS.  Do YOU make jewelry like medical IDs?  Are you a crafter with an online shop - I wanna know!  Email me at [email protected]

Severe recurrent hypoglycemia after gastric bypass surgery.

Someone sent this link to me yesterday - it's about a study that treated several people with severe hypoglycemia after gastric bypass with silastic bands or lap bands over their roux en y pouches - it worked, mostly.  Pancreas surgery is considered the second line of defense after trying this first.  (Good to know.)

I would not mind having a band put in to stop the hypoglycemia if it becomes necessary to treat.  Pancreatic surgery scares me.

1: Obes Surg. 2008 Aug;18(8):981-8. Epub 2008 Apr 26.

Related Articles, Links

Severe recurrent hypoglycemia after gastric bypass surgery.

Z'graggen K, Guweidhi A, Steffen R, Potoczna N, Biral R, Walther F, Komminoth P, Horber F.

Berner Viszeralchirurgie and Schweizerisches Pankreaszentrum Klinik Beau-Site Bern, Bern, Switzerland.

BACKGROUND: Bariatric surgery is, at present, the most effective method to achieve major, long-term weight loss in severely obese patients. Recently, severe recurrent symptomatic hyperinsulinemic hypoglycemia was described as a consequence of gastric bypass surgery (GBS) in a small series of patients with severe obesity. Pancreatic nesidioblastosis, a hyperplasia of islet cells, was postulated to be the cause, and subtotal or total pancreatectomy was the suggested treatment. METHODS: We observed that severe, disabling hypoglycemia after GBS occurred only in patients with loss of restriction. Whether restoration of gastric restriction might treat severe, recurrent hypoglycemia after GBS is unknown.

RESULTS: Therefore, gastric restriction was restored by surgical placement of a silastic ring (n = 8, first two patients with additional distal pancreatectomy) or an adjustable gastric band (n = 4) around the pouch in 12 consecutive patients presenting with severe hypoglycemia (blood glucose below 2.2 mM). At follow-up after restoration of gastric restriction (median follow-up 7 months, range 5 to 19 months), 11 patients demonstrated no hypoglycemic episodes, while one had recurrence of hypoglycemia and underwent distal pancreatectomy. Procedural mortality was 0% and morbidity 8.3%. CONCLUSION: Patients suffering from severe recurrent hypoglycemia after GBS can be treated, in most cases, just by restoration of gastric restriction. Distal pancreatectomy should be considered a second-line treatment.

PMID: 18438618 [PubMed - indexed for MEDLINE]

New Survey Results Show Huge Burden of Diabetes

http://www.nih.gov/news/health/jan2009/niddk-26.htm

For Immediate Release Monday, January 26, 2009

Study Includes Sensitive Test of Blood Glucose Abnormalities

In the United States, nearly 13 percent of adults age 20 and older have diabetes, but 40 percent of them have not been diagnosed, according to epidemiologists from the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), whose study includes newly available data from an Oral Glucose Tolerance Test (OGTT). Diabetes is especially common in the elderly: nearly one-third of those age 65 and older have the disease. An additional 30 percent of adults have pre-diabetes, a condition marked by elevated blood sugar that is not yet in the diabetic range. The researchers report these findings in the February 2009 issue of Diabetes Care, which posted a pre-print version of the article online at http://diabetes.org/diabetescare.

The study compared the results of two national surveys that included a fasting blood glucose (FBG) test and 2-hour glucose reading from an OGTT. The OGTT gives more information about blood glucose abnormalities than the FBG test, which measures blood glucose after an overnight fast. The FBG test is easier and less costly than the OGTT, but the 2-hour test is more sensitive in identifying diabetes and pre-diabetes, especially in older people. Two-hour glucose readings that are high but not yet diabetic indicate a greater risk of cardiovascular disease and of developing diabetes than a high, but not yet diabetic, fasting glucose level.

“We’re facing a diabetes epidemic that shows no signs of abating, judging from the number of individuals with pre-diabetes,” said lead author Catherine Cowie, Ph.D., of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a part of the NIH. “For years, diabetes prevalence estimates have been based mainly on data that included a fasting glucose test but not an OGTT. The 2005-2006 National Health and Nutrition Examination Survey, or NHANES, is the first national survey in 15 years to include the OGTT. The addition of the OGTT gives us greater confidence that we’re seeing the true burden of diabetes and pre-diabetes in a representative sample of the U.S. population.”

Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. It is the most common cause of blindness, kidney failure, and amputations in adults and a leading cause of heart disease and stroke. Type 2 diabetes accounts for up to 95 percent of all diabetes cases and virtually all cases of undiagnosed diabetes. Pre-diabetes, which causes no symptoms, substantially raises the risk of a heart attack or stroke and of developing type 2 diabetes.

In its analysis, the team also found that:

• The rate of diagnosed diabetes increased between the surveys, but the prevalence of undiagnosed diabetes and pre-diabetes remained relatively stable.
• Minority groups continue to bear a disproportionate burden. The prevalence of diabetes, both diagnosed and undiagnosed, in non-Hispanic blacks and Mexican- Americans is about 70 to 80 percent higher than that of non-Hispanic whites.
• Diabetes prevalence was virtually the same in men and women, as was the proportion of undiagnosed cases.
• Pre-diabetes is more common in men than in women (36 percent compared to 23 percent).
• Diabetes is rare in youth ages 12 to 19 years, but about 16 percent have pre-diabetes.

Cityfeast "Dining Out To Conquer Diabetes" - Joslin

Boston, MA -

Please join us for a five-course dinner with wine pairings at your choice of one of Boston's exclusive North End restaurants. Proceeds to benefit Joslin Diabetes Center's High Hopes Fund. Special guest appearance by Billy Costa of KISS 108 FM and NECN's TV Diner.

Sunday, January 25, 2009
6:00 p.m.

Tickets: $150
*$100 of the ticket price is tax-deductible.

Space is limited -- make your reservations soon!
Contact Michelle Coletta at (617) 264-2777

Participating Restaurants: