Guest guest Posted November 23, 2005 Report Share Posted November 23, 2005 She may need to be seen by an endocrinologist to evaluate if she has hyperinsulinemia that could be from an insulinoma or expansion of beta cells. These things are rare but can happen and need to be ruled out in anyone with more severe hypoglycemia. Diane Olson MS, RD, CDE -----Original Message-----From: [mailto: ] On Behalf Of ODonnellSent: Tuesday, November 22, 2005 3:02 PM Subject: hypoglycemia Hi All, I have a pt who is s/p gastric bypass surgery 2 years ago. She has lost 65% of her excess body weight however it has slowed down. Pt is grazing throughout the day on various items such as crackers, pretzels ect. She is hypoglycemic and reports blood sugars in the 50's if she doesnt snack. I placed pt on a 1200kcal meal plan that includes btw meal snacks (even though I am opposed to btw meal snacking), focusing on dairy, protein or fruit. Do any of you have any other suggestions for me? I dont want her to gain weight by snacking but then again I dont want her blood sugars to drop too low. Any thoughts would be greatly appreciated. Thank you, O'Donnell RD, LD Outpatient Dietitian SMMC Biddeford Maine, 04005 FareChase - Search multiple travel sites in one click. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 2005 Report Share Posted November 27, 2005 , I've had an almost identical pt situation recently. My pt issue was not snacking during the day, but failure to exercise (diminished w/illness, and never resumed). She occasionally snacked on the wrong things. My recommendation was to do 1400 kcals daily w/6 planned meals/snacks. It was about a 45% carb, 20% pro, 35% fat breakdown (emphasis on the healthy fats). One fat was planned with each meal and snack. She, too, had issues w/BG levels around 50-60. She is to see me for f/u in 4 weeks. I'll evaluate how closely she followed meal plan, if she did indeed resume exercise, how her BG levels have been and how she feels. I'll cut it down to 1200 if she is in good control and desires faster weight loss. Kim > > Hi All, > I have a pt who is s/p gastric bypass surgery 2 years ago. She has lost 65% of her excess body weight however it has slowed down. Pt is grazing throughout the day on various items such as crackers, pretzels ect. She is hypoglycemic and reports blood sugars in the 50's if she doesnt snack. > I placed pt on a 1200kcal meal plan that includes btw meal snacks (even though I am opposed to btw meal snacking), focusing on dairy, protein or fruit. Do any of you have any other suggestions for me? I dont want her to gain weight by snacking but then again I dont want her blood sugars to drop too low. Any thoughts would be greatly appreciated. Thank you, > O'Donnell RD, LD > Outpatient Dietitian > SMMC > Biddeford Maine, 04005 > > > --------------------------------- > FareChase - Search multiple travel sites in one click. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 2005 Report Share Posted November 27, 2005 I checked the files and did not locate it. What is it entitled? Kim > > > There is a great handout in the files section on reactive hypoglycemia. > > > > > |---------+--------------------------------------------> > | | ODonnell | > | | <jlod2@y...> | > | | Sent by: | > | | @yaho| > | | ogroups.com | > | | | > | | | > | | 11/22/2005 03:01 PM | > | | Please respond to | > | | | > | | | > |---------+--------------------------------------------> > >----------------------------------------------------------------- -----------------------------| > | | > | To: | > | cc: | > | Subject: hypoglycemia | > >----------------------------------------------------------------- -----------------------------| > > > > > Hi All, > I have a pt who is s/p gastric bypass surgery 2 years ago. She has lost > 65% of her excess body weight however it has slowed down. Pt is grazing > throughout the day on various items such as crackers, pretzels ect. She is > hypoglycemic and reports blood sugars in the 50's if she doesnt snack. > I placed pt on a 1200kcal meal plan that includes btw meal snacks (even > though I am opposed to btw meal snacking), focusing on dairy, protein or > fruit. Do any of you have any other suggestions for me? I dont want her > to gain weight by snacking but then again I dont want her blood sugars to > drop too low. Any thoughts would be greatly appreciated. Thank you, > O'Donnell RD, LD > Outpatient Dietitian > SMMC > Biddeford Maine, 04005 > > > FareChase - Search multiple travel sites in one click. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2006 Report Share Posted December 12, 2006 Also monitor her total carbs throughout the day along with the amt at each meal. Many post-ops forget about carbs b/c they focus on protein (which they need too-don’t get me wrong). If you can get her consuming 100-130g of carbs (complex of course) that should help with the hypoglycemia along with pairing protein with carb. She can dilute the juice with water (50/50) to decrease sugar. From: [mailto: ] On Behalf Of ODonnell Sent: Tuesday, December 12, 2006 9:27 AM To: Subject: hypoglycemia Hi All, I have a pt one year post op who came to see me today. She has been experiencing hypoglycemic episodes (sometimes as low as 50). Pt is currently 5'5 " and weighs 143. I recommended small frequent meals containing 15g carbohydrate at each meal w/ some protein. I told her to avoid simple sugars and to consume mostly whole grains. Any suggestions when her blood sugar drops too low? Should I recommend juice since it will bring her sugar up more quickly? (I am worried about the dumping, but if its only in 4 oz portions?) She will be keeping a food log for me along w/ a blood sugar log for our next visit. Any suggestions would be greatly appreciated! Thank you, O'Donnell RD, LD SMMC Any questions? Get answers on any topic at Answers. Try it now. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2006 Report Share Posted December 12, 2006 I would recommend a glucose source like tabs. They're faster, easier to carry and less likely for the pt to get too much or use to often. And they're cheap at Walmart. Beverly Millison MS RD/LD CDE hypoglycemia Hi All, I have a pt one year post op who came to see me today. She has been experiencing hypoglycemic episodes (sometimes as low as 50). Pt is currently 5'5" and weighs 143. I recommended small frequent meals containing 15g carbohydrate at each meal w/ some protein. I told her to avoid simple sugars and to consume mostly whole grains. Any suggestions when her blood sugar drops too low? Should I recommend juice since it will bring her sugar up more quickly? (I am worried about the dumping, but if its only in 4 oz portions?) She will be keeping a food log for me along w/ a blood sugar log for our next visit. Any suggestions would be greatly appreciated! Thank you, O'Donnell RD, LDSMMC Any questions? Get answers on any topic at Answers. Try it now. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2006 Report Share Posted December 12, 2006 If there is no improvement with proper eating then she needs to be referred to an Endocrinologist, preferably one familiar with bariatrics, nesidioblastosis is a possibility. Laschkewitsch RD LDDietitian, Legacy Obesity Institute(503) 413-8135 -----Original Message-----From: [mailto: ]On Behalf Of ODonnellSent: Tuesday, December 12, 2006 6:27 AM Subject: hypoglycemia Hi All, I have a pt one year post op who came to see me today. She has been experiencing hypoglycemic episodes (sometimes as low as 50). Pt is currently 5'5" and weighs 143. I recommended small frequent meals containing 15g carbohydrate at each meal w/ some protein. I told her to avoid simple sugars and to consume mostly whole grains. Any suggestions when her blood sugar drops too low? Should I recommend juice since it will bring her sugar up more quickly? (I am worried about the dumping, but if its only in 4 oz portions?) She will be keeping a food log for me along w/ a blood sugar log for our next visit. Any suggestions would be greatly appreciated! Thank you, O'Donnell RD, LDSMMC Any questions? Get answers on any topic at Answers. Try it now. IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2006 Report Share Posted December 12, 2006 Beverly! Can patient have dumping after eating glucose pills? -- In , " Bevlyann " <bevlyann@...> wrote: > > I would recommend a glucose source like tabs. They're faster, easier to carry and less likely for the pt to get too much or use to often. And they're cheap at Walmart. > > Beverly Millison MS RD/LD CDE > > hypoglycemia > > > > Hi All, > I have a pt one year post op who came to see me today. She has been experiencing hypoglycemic episodes (sometimes as low as 50). Pt is currently 5'5 " and weighs 143. I recommended small frequent meals containing 15g carbohydrate at each meal w/ some protein. I told her to avoid simple sugars and to consume mostly whole grains. Any suggestions when her blood sugar drops too low? Should I recommend juice since it will bring her sugar up more quickly? (I am worried about the dumping, but if its only in 4 oz portions?) She will be keeping a food log for me along w/ a blood sugar log for our next visit. Any suggestions would be greatly appreciated! Thank you, > O'Donnell RD, LD > SMMC > > > ------------------------------------------------------------------- ----------- > Any questions? Get answers on any topic at Answers. Try it now. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2006 Report Share Posted December 12, 2006 ! There is a handout about reactive hypoglycemia. Look under FILES/ Post-Procedure Education. > > Hi All, > I have a pt one year post op who came to see me today. She has been experiencing hypoglycemic episodes (sometimes as low as 50). Pt is currently 5'5 " and weighs 143. I recommended small frequent meals containing 15g carbohydrate at each meal w/ some protein. I told her to avoid simple sugars and to consume mostly whole grains. Any suggestions when her blood sugar drops too low? Should I recommend juice since it will bring her sugar up more quickly? (I am worried about the dumping, but if its only in 4 oz portions?) She will be keeping a food log for me along w/ a blood sugar log for our next visit. Any suggestions would be greatly appreciated! Thank you, > O'Donnell RD, LD > SMMC > > > --------------------------------- > Any questions? Get answers on any topic at Answers. Try it now. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2006 Report Share Posted December 12, 2006 This is not a response to the email re: glucose, but I sent a separate email and it came back to me undeliverable. My question for the group: What probiotics are you recommending that you believe are viable ? We are having a couple of pts 18-24 mo post-op with increased gas. I'm wondering about their bowel ecology at this point. Any thoughts you have will be appreciated ! Strathdee, RD, LD, LMHC Genesis Medical Center Davenport, IA >>> bevlyann@... 12/12/2006 10:06 AM >>> I would recommend a glucose source like tabs. They're faster, easier to carry and less likely for the pt to get too much or use to often. And they're cheap at Walmart. Beverly Millison MS RD/LD CDE hypoglycemia Hi All, I have a pt one year post op who came to see me today. She has been experiencing hypoglycemic episodes (sometimes as low as 50). Pt is currently 5'5 " and weighs 143. I recommended small frequent meals containing 15g carbohydrate at each meal w/ some protein. I told her to avoid simple sugars and to consume mostly whole grains. Any suggestions when her blood sugar drops too low? Should I recommend juice since it will bring her sugar up more quickly? (I am worried about the dumping, but if its only in 4 oz portions?) She will be keeping a food log for me along w/ a blood sugar log for our next visit. Any suggestions would be greatly appreciated! Thank you, O'Donnell RD, LD SMMC ------------------------------------------------------------------------------ Any questions? Get answers on any topic at Answers. Try it now. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2006 Report Share Posted December 12, 2006 YOu know, I'm not totally sure but I would think the likelihood might be diminished but still there. I don't work with bypass pts much so I don't have any experience with it first hand. This is what I do with my band pts and diabetes pts. But they are going to have to get the glucose up some how so I would think this would be the best and follow with a protein and fat. hypoglycemia> > > > Hi All,> I have a pt one year post op who came to see me today. She has been experiencing hypoglycemic episodes (sometimes as low as 50). Pt is currently 5'5" and weighs 143. I recommended small frequent meals containing 15g carbohydrate at each meal w/ some protein. I told her to avoid simple sugars and to consume mostly whole grains. Any suggestions when her blood sugar drops too low? Should I recommend juice since it will bring her sugar up more quickly? (I am worried about the dumping, but if its only in 4 oz portions?) She will be keeping a food log for me along w/ a blood sugar log for our next visit. Any suggestions would be greatly appreciated! Thank you,> O'Donnell RD, LD> SMMC> > > ---------------------------------------------------------------------> Any questions? Get answers on any topic at Answers. Try it now.> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2006 Report Share Posted December 12, 2006 I would encourage plain Kefir From: [mailto: ] On Behalf Of Strathdee Sent: Tuesday, December 12, 2006 11:38 AM Subject: Re: hypoglycemia This is not a response to the email re: glucose, but I sent a separate email and it came back to me undeliverable. My question for the group: What probiotics are you recommending that you believe are viable ? We are having a couple of pts 18-24 mo post-op with increased gas. I'm wondering about their bowel ecology at this point. Any thoughts you have will be appreciated ! Strathdee, RD, LD, LMHC Genesis Medical Center Davenport, IA >>> bevlyanncomcast (DOT) net 12/12/2006 10:06 AM >>> I would recommend a glucose source like tabs. They're faster, easier to carry and less likely for the pt to get too much or use to often. And they're cheap at Walmart. Beverly Millison MS RD/LD CDE hypoglycemia Hi All, I have a pt one year post op who came to see me today. She has been experiencing hypoglycemic episodes (sometimes as low as 50). Pt is currently 5'5 " and weighs 143. I recommended small frequent meals containing 15g carbohydrate at each meal w/ some protein. I told her to avoid simple sugars and to consume mostly whole grains. Any suggestions when her blood sugar drops too low? Should I recommend juice since it will bring her sugar up more quickly? (I am worried about the dumping, but if its only in 4 oz portions?) She will be keeping a food log for me along w/ a blood sugar log for our next visit. Any suggestions would be greatly appreciated! Thank you, O'Donnell RD, LD SMMC ---------------------------------------------------------- Any questions? Get answers on any topic at Answers. Try it now. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 9, 2007 Report Share Posted January 9, 2007 Hi All, I had posted a question about a month ago in regards to hypoglycemia. The pt came back today very irritable, unable to concentrate, chronic "head pain" (not a headache, rather pain which was difficult to describe). Pt has been eating every 2 hours including 15-30g carbohydrate each meal, she has only been checking her blood sugars when she feels "low" vs 2 hours after a meal. She will be seeing an endocrinologist this month. Anything else I could suggest through her diet? She isnt drinking enough-only a cup of coffee/tea daily. Pt has a difficult time tolerating cold liquids-only at room temperature. I told her to aim for 64 oz fluid/day which may help w/ subside the symptoms a bit. I just want to make sure I am doing everything from my end. shes very discouraged and I can't imagine feeling that way day in and day out. Any thoughts would be greatly appreciated. Thank you, O'Donnell"Laschkwitsch, :LPH Obes Inst" <KLaschke@...> wrote: If there is no improvement with proper eating then she needs to be referred to an Endocrinologist, preferably one familiar with bariatrics, nesidioblastosis is a possibility. Laschkewitsch RD LDDietitian, Legacy Obesity Institute(503) 413-8135 -----Original Message-----From: [mailto: ]On Behalf Of ODonnellSent: Tuesday, December 12, 2006 6:27 AM Subject: hypoglycemia Hi All, I have a pt one year post op who came to see me today. She has been experiencing hypoglycemic episodes (sometimes as low as 50). Pt is currently 5'5" and weighs 143. I recommended small frequent meals containing 15g carbohydrate at each meal w/ some protein. I told her to avoid simple sugars and to consume mostly whole grains. Any suggestions when her blood sugar drops too low? Should I recommend juice since it will bring her sugar up more quickly? (I am worried about the dumping, but if its only in 4 oz portions?) She will be keeping a food log for me along w/ a blood sugar log for our next visit. Any suggestions would be greatly appreciated! Thank you, O'Donnell RD, LDSMMC Any questions? Get answers on any topic at Answers. Try it now. IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature. __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 9, 2007 Report Share Posted January 9, 2007 Hi All, I had posted a question about a month ago in regards to hypoglycemia. The pt came back today very irritable, unable to concentrate, chronic "head pain" (not a headache, rather pain which was difficult to describe). Pt has been eating every 2 hours including 15-30g carbohydrate each meal, she has only been checking her blood sugars when she feels "low" vs 2 hours after a meal. She will be seeing an endocrinologist this month. Anything else I could suggest through her diet? She isnt drinking enough-only a cup of coffee/tea daily. Pt has a difficult time tolerating cold liquids-only at room temperature. I told her to aim for 64 oz fluid/day which may help w/ subside the symptoms a bit. I just want to make sure I am doing everything from my end. shes very discouraged and I can't imagine feeling that way day in and day out. Any thoughts would be greatly appreciated. Thank you, O'Donnell"Laschkwitsch, :LPH Obes Inst" <KLaschke@...> wrote: If there is no improvement with proper eating then she needs to be referred to an Endocrinologist, preferably one familiar with bariatrics, nesidioblastosis is a possibility. Laschkewitsch RD LDDietitian, Legacy Obesity Institute(503) 413-8135 -----Original Message-----From: [mailto: ]On Behalf Of ODonnellSent: Tuesday, December 12, 2006 6:27 AM Subject: hypoglycemia Hi All, I have a pt one year post op who came to see me today. She has been experiencing hypoglycemic episodes (sometimes as low as 50). Pt is currently 5'5" and weighs 143. I recommended small frequent meals containing 15g carbohydrate at each meal w/ some protein. I told her to avoid simple sugars and to consume mostly whole grains. Any suggestions when her blood sugar drops too low? Should I recommend juice since it will bring her sugar up more quickly? (I am worried about the dumping, but if its only in 4 oz portions?) She will be keeping a food log for me along w/ a blood sugar log for our next visit. Any suggestions would be greatly appreciated! Thank you, O'Donnell RD, LDSMMC Any questions? Get answers on any topic at Answers. Try it now. IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature. __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 9, 2007 Report Share Posted January 9, 2007 What are her glucoses when she is low? She needs to test after meals to pinpoint patterns. Then you can make a plan to avoid them. I'm assuming she is a bypass pt? RE: hypoglycemia Hi All, I had posted a question about a month ago in regards to hypoglycemia. The pt came back today very irritable, unable to concentrate, chronic "head pain" (not a headache, rather pain which was difficult to describe). Pt has been eating every 2 hours including 15-30g carbohydrate each meal, she has only been checking her blood sugars when she feels "low" vs 2 hours after a meal. She will be seeing an endocrinologist this month. Anything else I could suggest through her diet? She isnt drinking enough-only a cup of coffee/tea daily. Pt has a difficult time tolerating cold liquids-only at room temperature. I told her to aim for 64 oz fluid/day which may help w/ subside the symptoms a bit. I just want to make sure I am doing everything from my end. shes very discouraged and I can't imagine feeling that way day in and day out. Any thoughts would be greatly appreciated. Thank you, O'Donnell"Laschkwitsch, :LPH Obes Inst" <KLaschkeLHS (DOT) ORG> wrote: If there is no improvement with proper eating then she needs to be referred to an Endocrinologist, preferably one familiar with bariatrics, nesidioblastosis is a possibility. Laschkewitsch RD LDDietitian, Legacy Obesity Institute(503) 413-8135 -----Original Message-----From: [mailto: ]On Behalf Of ODonnellSent: Tuesday, December 12, 2006 6:27 AM Subject: hypoglycemia Hi All, I have a pt one year post op who came to see me today. She has been experiencing hypoglycemic episodes (sometimes as low as 50). Pt is currently 5'5" and weighs 143. I recommended small frequent meals containing 15g carbohydrate at each meal w/ some protein. I told her to avoid simple sugars and to consume mostly whole grains. Any suggestions when her blood sugar drops too low? Should I recommend juice since it will bring her sugar up more quickly? (I am worried about the dumping, but if its only in 4 oz portions?) She will be keeping a food log for me along w/ a blood sugar log for our next visit. Any suggestions would be greatly appreciated! Thank you, O'Donnell RD, LDSMMC Any questions? Get answers on any topic at Answers. Try it now. IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature. __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 9, 2007 Report Share Posted January 9, 2007 What are her glucoses when she is low? She needs to test after meals to pinpoint patterns. Then you can make a plan to avoid them. I'm assuming she is a bypass pt? RE: hypoglycemia Hi All, I had posted a question about a month ago in regards to hypoglycemia. The pt came back today very irritable, unable to concentrate, chronic "head pain" (not a headache, rather pain which was difficult to describe). Pt has been eating every 2 hours including 15-30g carbohydrate each meal, she has only been checking her blood sugars when she feels "low" vs 2 hours after a meal. She will be seeing an endocrinologist this month. Anything else I could suggest through her diet? She isnt drinking enough-only a cup of coffee/tea daily. Pt has a difficult time tolerating cold liquids-only at room temperature. I told her to aim for 64 oz fluid/day which may help w/ subside the symptoms a bit. I just want to make sure I am doing everything from my end. shes very discouraged and I can't imagine feeling that way day in and day out. Any thoughts would be greatly appreciated. Thank you, O'Donnell"Laschkwitsch, :LPH Obes Inst" <KLaschkeLHS (DOT) ORG> wrote: If there is no improvement with proper eating then she needs to be referred to an Endocrinologist, preferably one familiar with bariatrics, nesidioblastosis is a possibility. Laschkewitsch RD LDDietitian, Legacy Obesity Institute(503) 413-8135 -----Original Message-----From: [mailto: ]On Behalf Of ODonnellSent: Tuesday, December 12, 2006 6:27 AM Subject: hypoglycemia Hi All, I have a pt one year post op who came to see me today. She has been experiencing hypoglycemic episodes (sometimes as low as 50). Pt is currently 5'5" and weighs 143. I recommended small frequent meals containing 15g carbohydrate at each meal w/ some protein. I told her to avoid simple sugars and to consume mostly whole grains. Any suggestions when her blood sugar drops too low? Should I recommend juice since it will bring her sugar up more quickly? (I am worried about the dumping, but if its only in 4 oz portions?) She will be keeping a food log for me along w/ a blood sugar log for our next visit. Any suggestions would be greatly appreciated! Thank you, O'Donnell RD, LDSMMC Any questions? Get answers on any topic at Answers. Try it now. IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature. __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 9, 2007 Report Share Posted January 9, 2007 First, how much protein is she consuming? Is she doing whey protein shakes or attempting to get all of her protein requirements from food (not gonna happen if she's RNY or BPD/DS in my experience)? Second, what are her B1, B6, and B12 levels? How about HGB, HCT, iron and ferritin? Might be a good idea to run a full set of labs and tweak her supplements as necessary. You're right . . . she's got to get in more fluids. Pure water is best but if she won't do that, suggest she try the 0-calorie flavored waters, DIET V8 Juice Splash, Crystal Light or even SF popsicles. Steve Huntington, PhD, RD, LD > > Hi All, > I had posted a question about a month ago in regards to hypoglycemia. The pt came back today very irritable, unable to concentrate, chronic " head pain " (not a headache, rather pain which was difficult to describe). Pt has been eating every 2 hours including 15-30g carbohydrate each meal, she has only been checking her blood sugars when she feels " low " vs 2 hours after a meal. She will be seeing an endocrinologist this month. Anything else I could suggest through her diet? She isnt drinking enough-only a cup of coffee/tea daily. Pt has a difficult time tolerating cold liquids-only at room temperature. I told her to aim for 64 oz fluid/day which may help w/ subside the symptoms a bit. I just want to make sure I am doing everything from my end. shes very discouraged and I can't imagine feeling that way day in and day out. Any thoughts would be greatly appreciated. Thank you, > O'Donnell Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 9, 2007 Report Share Posted January 9, 2007 First, how much protein is she consuming? Is she doing whey protein shakes or attempting to get all of her protein requirements from food (not gonna happen if she's RNY or BPD/DS in my experience)? Second, what are her B1, B6, and B12 levels? How about HGB, HCT, iron and ferritin? Might be a good idea to run a full set of labs and tweak her supplements as necessary. You're right . . . she's got to get in more fluids. Pure water is best but if she won't do that, suggest she try the 0-calorie flavored waters, DIET V8 Juice Splash, Crystal Light or even SF popsicles. Steve Huntington, PhD, RD, LD > > Hi All, > I had posted a question about a month ago in regards to hypoglycemia. The pt came back today very irritable, unable to concentrate, chronic " head pain " (not a headache, rather pain which was difficult to describe). Pt has been eating every 2 hours including 15-30g carbohydrate each meal, she has only been checking her blood sugars when she feels " low " vs 2 hours after a meal. She will be seeing an endocrinologist this month. Anything else I could suggest through her diet? She isnt drinking enough-only a cup of coffee/tea daily. Pt has a difficult time tolerating cold liquids-only at room temperature. I told her to aim for 64 oz fluid/day which may help w/ subside the symptoms a bit. I just want to make sure I am doing everything from my end. shes very discouraged and I can't imagine feeling that way day in and day out. Any thoughts would be greatly appreciated. Thank you, > O'Donnell Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 9, 2007 Report Share Posted January 9, 2007 What are her B6, folate, B12 and MMA levels? Irritability, difficulty concentrating, and headache can all indicate anemia. Ava > If there is no improvement with proper eating then she needs to be referred to an Endocrinologist, preferably one familiar with bariatrics, nesidioblastosis is a possibility. > > Laschkewitsch RD LD > Dietitian, Legacy Obesity Institute > (503) 413-8135 > > hypoglycemia > > > Hi All, > I have a pt one year post op who came to see me today. She has been experiencing hypoglycemic episodes (sometimes as low as 50). Pt is currently 5'5 " and weighs 143. I recommended small frequent meals containing 15g carbohydrate at each meal w/ some protein. I told her to avoid simple sugars and to consume mostly whole grains. Any suggestions when her blood sugar drops too low? Should I recommend juice since it will bring her sugar up more quickly? (I am worried about the dumping, but if its only in 4 oz portions?) She will be keeping a food log for me along w/ a blood sugar log for our next visit. Any suggestions would be greatly appreciated! Thank you, > O'Donnell RD, LD > SMMC > > --------------------------------- > Any questions? Get answers on any topic at Answers. Try it now. > > > > > IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature. > > > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 9, 2007 Report Share Posted January 9, 2007 What are her B6, folate, B12 and MMA levels? Irritability, difficulty concentrating, and headache can all indicate anemia. Ava > If there is no improvement with proper eating then she needs to be referred to an Endocrinologist, preferably one familiar with bariatrics, nesidioblastosis is a possibility. > > Laschkewitsch RD LD > Dietitian, Legacy Obesity Institute > (503) 413-8135 > > hypoglycemia > > > Hi All, > I have a pt one year post op who came to see me today. She has been experiencing hypoglycemic episodes (sometimes as low as 50). Pt is currently 5'5 " and weighs 143. I recommended small frequent meals containing 15g carbohydrate at each meal w/ some protein. I told her to avoid simple sugars and to consume mostly whole grains. Any suggestions when her blood sugar drops too low? Should I recommend juice since it will bring her sugar up more quickly? (I am worried about the dumping, but if its only in 4 oz portions?) She will be keeping a food log for me along w/ a blood sugar log for our next visit. Any suggestions would be greatly appreciated! Thank you, > O'Donnell RD, LD > SMMC > > --------------------------------- > Any questions? Get answers on any topic at Answers. Try it now. > > > > > IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature. > > > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 9, 2007 Report Share Posted January 9, 2007 ,Evaluate what type of CHO she is eating. Very low fiber CHO especially 15-30 g with very little protein at meals will cause her blood sugars to be on a rollar coaster and eating q 2 hours as describes below. Most of my patients tend to experience reactive hypoglycemia >6 month after surgery with or without a history of diabetes secondary to insulin sensitivity with rapid weight loss and smaller portions. Increasing fluids is probably the first thing she needs to do considering she is only consuming 1 cup of beverage/d. Plain water is her best choice and avoid caffiene. Then have her focus on higher fiber, complex carbohydrates (fruits, vegetables, whole grains, beans, legumes) combined with lean protein and this will help her regulate the blood sugars instead of having to chase her lows every 2 hours. I've used this approach with many patients and proven to help as long as the patients takes personal responsibility for eating habits. Good guidelines to present to your patient would be >3 g fiber/meal and 8 g protein/meal. It will help them avoid the refined and concentrated CHO's which are more readily available. Patients are use to focusing on Protein that they don't learn about healthy CHO's. Patients can't sustain a CHO intake of <120 g /d on a long-term weight control meal plan so it is better to teach them Good CHO choices and how to combine with lean protein food choices. There are some really good handouts in the file section. Also, I would get a full lab panel to check for any deficiencies but the symptoms you mention are common ones my patients mentioned when they either are experiencing reactive hypoglycemia or dehydration. Have her keep a food diary to monitor her eating habits and behaviors as well plus you are able to give her advice on how to incorporate more high fiber CHO's. If you have any questions please feel free to email me. Beth Wheln, MS, RD, LD ODonnell <jlod2@...> wrote: Hi All, I had posted a question about a month ago in regards to hypoglycemia. The pt came back today very irritable, unable to concentrate, chronic "head pain" (not a headache, rather pain which was difficult to describe). Pt has been eating every 2 hours including 15-30g carbohydrate each meal, she has only been checking her blood sugars when she feels "low" vs 2 hours after a meal. She will be seeing an endocrinologist this month. Anything else I could suggest through her diet? She isnt drinking enough-only a cup of coffee/tea daily. Pt has a difficult time tolerating cold liquids-only at room temperature. I told her to aim for 64 oz fluid/day which may help w/ subside the symptoms a bit. I just want to make sure I am doing everything from my end. shes very discouraged and I can't imagine feeling that way day in and day out. Any thoughts would be greatly appreciated. Thank you, O'Donnell"Laschkwitsch, :LPH Obes Inst" <KLaschkeLHS (DOT) ORG> wrote: If there is no improvement with proper eating then she needs to be referred to an Endocrinologist, preferably one familiar with bariatrics, nesidioblastosis is a possibility. Laschkewitsch RD LDDietitian, Legacy Obesity Institute(503) 413-8135 -----Original Message-----From: [mailto: ]On Behalf Of ODonnellSent: Tuesday, December 12, 2006 6:27 AM Subject: hypoglycemia Hi All, I have a pt one year post op who came to see me today. She has been experiencing hypoglycemic episodes (sometimes as low as 50). Pt is currently 5'5" and weighs 143. I recommended small frequent meals containing 15g carbohydrate at each meal w/ some protein. I told her to avoid simple sugars and to consume mostly whole grains. Any suggestions when her blood sugar drops too low? Should I recommend juice since it will bring her sugar up more quickly? (I am worried about the dumping, but if its only in 4 oz portions?) She will be keeping a food log for me along w/ a blood sugar log for our next visit. Any suggestions would be greatly appreciated! Thank you, O'Donnell RD, LDSMMC Any questions? Get answers on any topic at Answers. Try it now. IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature. __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 9, 2007 Report Share Posted January 9, 2007 ,Evaluate what type of CHO she is eating. Very low fiber CHO especially 15-30 g with very little protein at meals will cause her blood sugars to be on a rollar coaster and eating q 2 hours as describes below. Most of my patients tend to experience reactive hypoglycemia >6 month after surgery with or without a history of diabetes secondary to insulin sensitivity with rapid weight loss and smaller portions. Increasing fluids is probably the first thing she needs to do considering she is only consuming 1 cup of beverage/d. Plain water is her best choice and avoid caffiene. Then have her focus on higher fiber, complex carbohydrates (fruits, vegetables, whole grains, beans, legumes) combined with lean protein and this will help her regulate the blood sugars instead of having to chase her lows every 2 hours. I've used this approach with many patients and proven to help as long as the patients takes personal responsibility for eating habits. Good guidelines to present to your patient would be >3 g fiber/meal and 8 g protein/meal. It will help them avoid the refined and concentrated CHO's which are more readily available. Patients are use to focusing on Protein that they don't learn about healthy CHO's. Patients can't sustain a CHO intake of <120 g /d on a long-term weight control meal plan so it is better to teach them Good CHO choices and how to combine with lean protein food choices. There are some really good handouts in the file section. Also, I would get a full lab panel to check for any deficiencies but the symptoms you mention are common ones my patients mentioned when they either are experiencing reactive hypoglycemia or dehydration. Have her keep a food diary to monitor her eating habits and behaviors as well plus you are able to give her advice on how to incorporate more high fiber CHO's. If you have any questions please feel free to email me. Beth Wheln, MS, RD, LD ODonnell <jlod2@...> wrote: Hi All, I had posted a question about a month ago in regards to hypoglycemia. The pt came back today very irritable, unable to concentrate, chronic "head pain" (not a headache, rather pain which was difficult to describe). Pt has been eating every 2 hours including 15-30g carbohydrate each meal, she has only been checking her blood sugars when she feels "low" vs 2 hours after a meal. She will be seeing an endocrinologist this month. Anything else I could suggest through her diet? She isnt drinking enough-only a cup of coffee/tea daily. Pt has a difficult time tolerating cold liquids-only at room temperature. I told her to aim for 64 oz fluid/day which may help w/ subside the symptoms a bit. I just want to make sure I am doing everything from my end. shes very discouraged and I can't imagine feeling that way day in and day out. Any thoughts would be greatly appreciated. Thank you, O'Donnell"Laschkwitsch, :LPH Obes Inst" <KLaschkeLHS (DOT) ORG> wrote: If there is no improvement with proper eating then she needs to be referred to an Endocrinologist, preferably one familiar with bariatrics, nesidioblastosis is a possibility. Laschkewitsch RD LDDietitian, Legacy Obesity Institute(503) 413-8135 -----Original Message-----From: [mailto: ]On Behalf Of ODonnellSent: Tuesday, December 12, 2006 6:27 AM Subject: hypoglycemia Hi All, I have a pt one year post op who came to see me today. She has been experiencing hypoglycemic episodes (sometimes as low as 50). Pt is currently 5'5" and weighs 143. I recommended small frequent meals containing 15g carbohydrate at each meal w/ some protein. I told her to avoid simple sugars and to consume mostly whole grains. Any suggestions when her blood sugar drops too low? Should I recommend juice since it will bring her sugar up more quickly? (I am worried about the dumping, but if its only in 4 oz portions?) She will be keeping a food log for me along w/ a blood sugar log for our next visit. Any suggestions would be greatly appreciated! Thank you, O'Donnell RD, LDSMMC Any questions? Get answers on any topic at Answers. Try it now. IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature. __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2007 Report Share Posted October 23, 2007 Look for reactive hypoglycemia after GBP or late dumping syndrome. In FILES you will find handout for reactive hypoglycemia. - In , " Musselman Tina " <tina.musselman@...> wrote: > > I have a pt 4 yrs post op with severe hypoglycemia. I am looking for > any full articles on the subject. I found many abstracts. In addition, > is there anything you have found particularly helpful from an RD > perscpective to prevent it. Her Blood Glu goes into the 40's and she > loses concentration an d focus and often cannot remember where is. She > is also wakes up multiple times during the night 2' to stress. > > > Tina Musselman RD, CCN > St. Bariatric Program Coordinator > (708) 679-2717 phone > (708) 679-2418 fax > tina.musselman@... > > > > ________________________________ > > From: > [mailto: ] On Behalf Of > Marina Savelyeva > Sent: Monday, October 22, 2007 4:30 PM > > Subject: Re: Weight Requirements for > WeightLoss Surgery > > > > It is also depends on a state. Aethna's requirements in California > may be different from Aethna's req. in New York > > - In > <mailto:% 40> , " Laschkwitsch, > > :LPH Obes Inst " <KLaschke@> wrote: > > > > We have had some be denied by insurance company if they no longer > meet that > > insurance companies requirements, i.e. some have to have BMI of 40 > or more > > with 2 comorbidities and if they drop below this pre-surgery then > they may > > not be authorized for surgery. We have also had many insurance > companies > > that look at start weight vs post-counseling weight. It really > just > > depends on the specific insurance company. We have an insurance > > specialist in our office that checks each persons specific plan > and we tell > > them the criteria. I actually am really frustrated with how much > of a game > > it can become because some patients will not work on anything > during their > > 3-6 months of weight management if they know weight loss will > disqualify > > them; then I struggle to recommend them for surgery when they > demonstrate no > > committment to change. Would love to hear if anyone else has run > into this > > and how you have handled it. > > > > > > Laschkewitsch RD LD > > Dietitian, Legacy Obesity Institute > > (503) 413-8135 > > > > > > From: > <mailto:%40> > > [mailto: > <mailto:%40> ]On Behalf Of > Marina > > Savelyeva > > Sent: Saturday, October 20, 2007 9:29 PM > > > <mailto:%40> > > Subject: Re: Weight Requirements for > > WeightLoss Surgery > > > > > > > > ! If pt will have less than 100 lb EBW , you need to use the > > highest weight pt ever have. > > > > - In BariatricNutritionD > > <mailto:%40> > > -ietitians@, " Widiss " > > <tanyaw@> wrote: > > > > > > Thank you Brittany and Theresa for your responses. Your > > information is very helpful. I look forward to any additional > > information and responses as well. > > > > > > Widiss, RD, MFT > > > Registered Dietitian > > > Licensed Marriage and Family Therapist > > > tanyaw@ > > > (626) 447-0247 > > > > > > > > > Re: [bariatricNutrition-Dietitians] Weight Requirements > for > > WeightLoss Surgery > > > > > > > > > We found the same thing at our facility. > > > > > > Brittany Ray <brittany_ray_-rd@> wrote: > > > , > > > We have had this situation before. Most often when patients are > > required to do some type of medically supervised diet program > prior > > to insurance approval. Our experience has been, that insurance > > companies use the weight from the initial consultation. > > > > > > I have had several patients lose 20-30lbs in a six month diet > > program and still qualify, even if they have fallen below 100lbs > over > > ideal body weight. As long as the initial or starting weight meet > the > > criteria. > > > > > > Hope this helps! > > > > > > > > > Widiss <tanyaw@> wrote: > > > Hi All, > > > > > > I am receiving referrals for nutrition counseling prior to > weight > > loss surgery. I have one client with questions/concerns I would > like > > to check out with you all. > > > > > > She states that she has lost considerable amounts of weight in > the > > past and has been unable to keep the weight off. She has her mind > > set that weight loss surgery is the way for her to go. She is 5'7 " > > and currently weighs approx. 278#. She states that in order to be > > approved for weight loss surgery, she needs to be at least 100# > over > > desired weight. She doesn't know what number they use for desired > > weight. Her concern is that if she loses weight working with me, > she > > will be less than 100# over desired weight and, therefore, not > > qualify for the surgery. . > > > > > > I would appreciate any feedback you have regarding situations > such > > as this. Have you worked with patient's with this concern and, if > > so, what has happened? Is your experience that the person needs > > to be at least 100# over desired weight at the time of weight loss > > surgery to be approved? > > > > > > Thank you in advance for your responses. > > > > > > > > > Widiss, RD, MFT > > > Registered Dietitian > > > Licensed Marriage and Family Therapist > > > tanyaw@ > > > (626) 447-0247 > > > > > > > > > > > > > > > Brittany J. Ray, RD > > > Virginia Weight Loss Surgery Center > > > 2280 Opitz Blvd. Ste. 320 > > > Woodbridge, VA 22203 > > > T. 703-878-7610 F.703-878-7614 > > > ____________-_________-_________-_________-_________-__ > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 24, 2007 Report Share Posted October 24, 2007 Thank you Tina Musselman RD, CCN St. Bariatric Program Coordinator (708) 679-2717 phone (708) 679-2418 fax tina.musselman@... From: [mailto: ] On Behalf Of Marina SavelyevaSent: Tuesday, October 23, 2007 5:33 PM Subject: Re: hypoglycemia Look for reactive hypoglycemia after GBP or late dumping syndrome. In FILES you will find handout for reactive hypoglycemia.- In , "Musselman Tina" <tina.musselman@...> wrote:>> I have a pt 4 yrs post op with severe hypoglycemia. I am looking for> any full articles on the subject. I found many abstracts. In addition,> is there anything you have found particularly helpful from an RD> perscpective to prevent it. Her Blood Glu goes into the 40's and she> loses concentration an d focus and often cannot remember where is. She> is also wakes up multiple times during the night 2' to stress.> > > Tina Musselman RD, CCN > St. Bariatric Program Coordinator > (708) 679-2717 phone > (708) 679-2418 fax > tina.musselman@... > > > > ________________________________> > From: > [mailto: ] On Behalf Of> Marina Savelyeva> Sent: Monday, October 22, 2007 4:30 PM> > Subject: Re: Weight Requirements for> WeightLoss Surgery> > > > It is also depends on a state. Aethna's requirements in California > may be different from Aethna's req. in New York> > - In > <mailto:%40> , "Laschkwitsch,> > :LPH Obes Inst" <KLaschke@> wrote:> >> > We have had some be denied by insurance company if they no longer > meet that> > insurance companies requirements, i.e. some have to have BMI of 40 > or more> > with 2 comorbidities and if they drop below this pre-surgery then > they may> > not be authorized for surgery. We have also had many insurance > companies> > that look at start weight vs post-counseling weight. It really > just> > depends on the specific insurance company. We have an insurance> > specialist in our office that checks each persons specific plan > and we tell> > them the criteria. I actually am really frustrated with how much > of a game> > it can become because some patients will not work on anything > during their> > 3-6 months of weight management if they know weight loss will > disqualify> > them; then I struggle to recommend them for surgery when they > demonstrate no> > committment to change. Would love to hear if anyone else has run > into this> > and how you have handled it. > > > > > > Laschkewitsch RD LD> > Dietitian, Legacy Obesity Institute> > (503) 413-8135 > > > > > > From: > <mailto:%40> > > [mailto: > <mailto:%40> ]On Behalf Of > Marina> > Savelyeva> > Sent: Saturday, October 20, 2007 9:29 PM> > > <mailto:%40> > > Subject: Re: Weight Requirements for> > WeightLoss Surgery> > > > > > > > ! If pt will have less than 100 lb EBW , you need to use the > > highest weight pt ever have. > > > > - In BariatricNutritionD> > <mailto:%40>> > -ietitians@, " Widiss" > > <tanyaw@> wrote:> > >> > > Thank you Brittany and Theresa for your responses. Your > > information is very helpful. I look forward to any additional > > information and responses as well.> > > > > > Widiss, RD, MFT> > > Registered Dietitian > > > Licensed Marriage and Family Therapist> > > tanyaw@> > > (626) 447-0247> > > > > > > > > Re: [bariatricNutrition-Dietitians] Weight Requirements > for > > WeightLoss Surgery> > > > > > > > > We found the same thing at our facility.> > > > > > Brittany Ray <brittany_ray_-rd@> wrote: > > > , > > > We have had this situation before. Most often when patients are > > required to do some type of medically supervised diet program > prior > > to insurance approval. Our experience has been, that insurance > > companies use the weight from the initial consultation. > > > > > > I have had several patients lose 20-30lbs in a six month diet > > program and still qualify, even if they have fallen below 100lbs > over > > ideal body weight. As long as the initial or starting weight meet > the > > criteria. > > > > > > Hope this helps! > > > > > > > > > Widiss <tanyaw@> wrote:> > > Hi All,> > > > > > I am receiving referrals for nutrition counseling prior to > weight > > loss surgery. I have one client with questions/concerns I would > like > > to check out with you all.> > > > > > She states that she has lost considerable amounts of weight in > the > > past and has been unable to keep the weight off. She has her mind > > set that weight loss surgery is the way for her to go. She is 5'7" > > and currently weighs approx. 278#. She states that in order to be > > approved for weight loss surgery, she needs to be at least 100# > over > > desired weight. She doesn't know what number they use for desired > > weight. Her concern is that if she loses weight working with me, > she > > will be less than 100# over desired weight and, therefore, not > > qualify for the surgery. . > > > > > > I would appreciate any feedback you have regarding situations > such > > as this. Have you worked with patient's with this concern and, if > > so, what has happened? Is your experience that the person needs > > to be at least 100# over desired weight at the time of weight loss > > surgery to be approved?> > > > > > Thank you in advance for your responses.> > > > > > > > > Widiss, RD, MFT> > > Registered Dietitian > > > Licensed Marriage and Family Therapist> > > tanyaw@> > > (626) 447-0247> > > > > > > > > > > > > > > Brittany J. Ray, RD > > > Virginia Weight Loss Surgery Center > > > 2280 Opitz Blvd. Ste. 320 > > > Woodbridge, VA 22203 > > > T. 703-878-7610 F.703-878-7614 > > > ____________-_________-_________-_________-_________-__> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2008 Report Share Posted July 8, 2008 There are a few reports in the literature of "late dumping" or reactive hypoglycemia. There are a few theories as to why, one being that the pancreas has been so used to pumping out insulin that it's over producing. Look at: Service GJ et al. Hyperinsulinemic hypoglycemia with nesidoblastosis after GB surgery. NEJM 2005. 353(3):249-254. We recently had a 2 year post op with a very severe case of this...daily episodes and she couldn't work because of it. Goal is to slow gastric emptying so it includes whole grains, not eating simple sugars, not eating CHO alone and including fat or protein with CHO meals. She was very compliant, but was still having low BG episodes. She saw an endocrine specialist who dx her with nesidoblastosis after a 2 hr GTT which found elevated insulin (201) at the 1 hour mark with a BG at 140, then insulin at 33 at 2 hr mark and a BG of 34. She started on Proglycem this week to help raise her BG. First line of defense is diet, but it would be worth while to recommend she consult an endocrinologist if it persists after diet change. Good luck. Veldheer, RD, LDNClinical DietitianPenn State Milton S. Hershey Medical CenterMiddletown Clinic717-948-5180sveldheer@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 8, 2009 Report Share Posted January 8, 2009 Our nurse practitioner and I evaluate patients after bypass surgery with a series of questions on a routine post-op questionnaire related to hypoglycemic symptoms. If, after speaking with the patient, we rule out fasting hypoglycemia, dumping or other conditions that mimic hypoglycemia ( such as iron def), we capture info on a special questionnaire, provide glucometers and counsel patients on diet to avoid hypoglycemia. They are asked to keep a "symptom" journal and return in about 6 weeks to reevaluate. If blood sugars are normal during hypoglycemic-like periods, obviously something else is going on. If diet has alleviated symptoms, they return for routine follow up only. If symptoms persist, with documented low blood sugars, they are further evaluated with glucose tolerance testing and insulin levels, which is ordered and evaluated by the NP. I have attached both our hypoglycemia questionnaire and reactive hypoglycemia handout. Hope this helps. Ellen , MS, RD, CD Bariatric Dietitian Fletcher Health Care 353 Blair Park Road Williston, VT 05495 (802) 847-4844 From: [mailto: ] On Behalf Of kristen.smith46Sent: Thursday, January 08, 2009 8:29 AM Subject: hypoglycemia Hi! We have recently been having some patients become hypoglycemic after Gastric bypass surgery. I was just wondering if anyone had any suggestions on how to treat this? Thanks. , RD,CDNMontefiore Medical Center Bariatric Surgery Dietitian Quote Link to comment Share on other sites More sharing options...
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