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Gastric bypass determines an increase in incretin secretion and glucose excursions throughout the day and may sometimes entail the development of severe post-bariatric hypoglycemia (PBH). However, there is no consensus on the gold standard method for its diagnosis. In this study, we evaluated the usefulness of a mixed meal tolerance test (MMTT) and continuous glucose monitoring (CGM) for the diagnosis of PBH, defined as glucose levels

Amanda Sheehan,1 Mary Elizabeth Patti1,2 1Research Division, Joslin Diabetes Center, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USACorrespondence: Mary Elizabeth PattiResearch Division, Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215, USATel +1 617-309-1966Fax +1 617-309-2593Email Mary.elizabeth.patti@joslin.harvard.eduContext: Post-bariatric hypoglycemia (PBH) is an increasingly encountered complication of upper gastrointestinal surgery; the prevalence of this condition is anticipated to rise given yearly increases in bariatric surgical procedures. While PBH is incompletely understood, there is a growing body of research describing the associated factors, mechanisms, and treatment approaches for this condition.Evidence Acquisition: Data are integrated and summarized from studies of individuals affected by PBH and hypoglycemia following upper gastrointestinal surgery obtained from PubMed searches (1990– 2020).Evidence Synthesis: Information addressing etiology, incidence/prevalence, clinical characteristics, assessment, and treatment were reviewed and synthesized for the practicing physician. Literature reports were supplemented by clinical experience as indicated, when published data were not available.Conclusion: PBH can be life-altering and severe for a subset of individuals. Given the chronic nature of this condition, and sequelae of both acute and recurrent episodes, increasing provider awareness of both the condition and associated risk factors is critical for assessment, prompt diagnosis, treatment, and preoperative identification of individuals at risk.Keywords: hypoglycemia, post-bariatric hypoglycemia, upper gastrointestinal surgery, bariatric surgery

Tywanek Ewa, Trojanowska Paulina, Woźniak Magdalena, Wronecki Jakub, Zwolak Agnieszka, Łuczyk Robert Jan. Causes of hypoglycemia. Journal of Education, Health and Sport. 2019;9(9):905-911. eISNN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.3460625 http://ojs.ukw.edu.pl/index.php/johs/article/view/7514 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2019; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 25.08.2019. Revised: 31.08.2019. Accepted: 22.09.2019. Causes of hypoglycemia Ewa Tywanek1, Paulina Trojanowska2, Magdalena Woźniak3, Jabkub Wronecki4, Agnieszka Zwolak1, Robert Jan Łuczyk1 1Chair of Internal Medicine and Department of Internal Medicine in Nursing, Medical University of Lublin, Chodźki 7, 20-093 Lublin, Poland 2Department of Pediatric Neurology, Medical University of Lublin, A. Gębali 6, 20-093 Lublin, Poland 3Chair and Department of Endocrinology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland 4Chair and Department of Gastroenterology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; ABSTRACT: Introduction: Hypoglycemia is metabolic state of ogranism characterized by abnormally low blood glucose level. Due to International Hypoglycemia Study Group (2017) and following Polish Diabetes Association Guidelines is recognized with serum glucose below 70mg/dl – with or without accompanying symptoms, such as tremor or altered mental status or even hypoglycemic coma. Symptoms mentioned above may have huge impact on personal or social functioning of the patient. Purpose: To present a list of known causes of hypoglycemic state. Summary: Hypoglycemia is quite unpleasant and dangerous metabolic state that may be caused by multiple etiological factors. The most common cause of this condition is useing too much insulin in treatment of diabetes mellitus. Other diabetic drugs, such us for example sulphonylureas may result in hypoglycemia. Chemicals containing sulfhydryl group in their structure may result in severe hypoglycemia in progress of Insulin Autoimmune Syndrome (IAS). Organic basis of hypoglycemia due to increased amount of producing insulin may be recognized, in progress of pancreatic secreting tumor, called insulinoma. From the other hand functional abnormality of carbohydrate metabolism may be found. It’s called functional hypoglycemia and may develop due to presence of hyperinsulism and insulin resistance secondary to incorrect lifestyle and diet. Partly organic and functional cause of hypogycemia may be recognized after bariatric surgery. Fairy seldom hypoglycemia with low blood insulin level may be found. The example of this state constitutes Dodge-Potter Syndrome, when tumor is able to produce insulin-growth factor 2 (IGF-2) stimulating insulin receptor, what results in serum glucose reduction. Hypoglycemia, as very adverse state for human organism, should be closely diagnose and efficiently treated. Keywords: hypoglycemia; drug-induced hypoglycemia; insulinoma; Non-Islet cell tumors hypoglycemia; Dodge-Potter Syndrome; post-bariatric hypoglycemia

Context Post-bariatric hypoglycemia (PBH) is an increasingly encountered complication of upper gastrointestinal surgery; the prevalence of this condition is anticipated to rise given yearly increases in bariatric surgical procedures. While PBH is incompletely understood, there is a growing body of research describing the associated factors, mechanisms, and treatment approaches for this condition. Evidence Acquisition Data are integrated and summarized from studies of individuals affected by PBH and hypoglycemia following upper gastrointestinal surgery obtained from PubMed searches (1990–2020). Evidence Synthesis Information addressing etiology, incidence/prevalence, clinical characteristics, assessment, and treatment were reviewed and synthesized for the practicing physician. Literature reports were supplemented by clinical experience as indicated, when published data were not available. Conclusion PBH can be life-altering and severe for a subset of individuals. Given the chronic nature of this condition, and sequelae of both acute and recurrent episodes, increasing provider awareness of both the condition and associated risk factors is critical for assessment, prompt diagnosis, treatment, and preoperative identification of individuals at risk.

Hypoglycemia is a pathological condition characterized by a low plasma glucose concentration associated with typical autonomic and/or neuroglycopenic symptoms, and resolution of these symptoms with carbohydrate consumption. Hypoglycemia is quite common in clinical practice, particularly in insulin-treated patients with diabetes and in other inherited or acquired conditions involving the regulation of glucose metabolism. Beyond symptoms that might strongly affect the quality of life, hypoglycemia can lead to short- and long-term detrimental consequences for health. Hypoglycemia can be prevented by appropriate changes in dietary habits or by relevant modifications of the drug treatment. Several dietary approaches based on the intake of various carbohydrate foods have been tested for hypoglycemia prevention; among them uncooked cornstarch (UCS) has demonstrated a great efficacy. In this narrative review, we have summarized the current evidence on the UCS usefulness in some conditions characterized by high hypoglycemic risk, focusing on some inherited diseases −i.e. glycogen storage diseases and other rare disorders − and acquired conditions such as type 1 diabetes, postprandial hypoglycemia consequent to esophageal-gastric or bariatric surgery, and insulin autoimmune syndrome. We also considered the possible role of UCS during endurance exercise performance. Lastly, we have discussed the dose requirement, the side effects, the limitations of UCS use, and the plausible mechanisms by which UCS could prevent hypoglycemia.

Post-bariatric hypoglycemia (PBH) is an increasingly recognized long-term complication of bariatric surgery. The nutritional treatment of PBH includes a high-fiber diet and the restriction of soluble and high-glycemic index carbohydrates; however, these measures are not always enough to prevent hypoglycemia. We evaluated the efficacy of uncooked cornstarch, a low-glycemic index carbohydrate characterized by slow intestinal degradation and absorption, in addition to a high-fiber diet, for the treatment of PBH. We report the cases of two young women suffering from severe postprandial and fasting hypoglycemia following Roux-en-Y gastric bypass (RYGB). The patients underwent Continuous Glucose Monitoring (CGM) before and 12–16 weeks after the administration of uncooked cornstarch (respectively 1.25 g/kg b.w. and 1.8 g/kg b.w.) in addition to a high-fiber diet. In both patients, CGM showed more stable glucose levels throughout monitoring, a remarkable reduction of the time spent in hypoglycemia (