Guest guest Posted May 11, 2006 Report Share Posted May 11, 2006 Does anyone have experiences with RNY-related nesidioblastosis? Is anyone using any protocol to screen their hypoglycemic pts for this? Do I correctly assume that if dietary changes don't help those with post op RNY-related hypoglycemia, that an endocrine consult is the next step? Hegmann, MSRD, LDN Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 11, 2006 Report Share Posted May 11, 2006 We refer all our 'NB' suspected patients to an Endocrinologist right off the bat however I do talk to them about dietary guidelines for hypoglycemia and make sure they are doing what they can to limit hypoglycemia, we do not have a protocol per se but I do encourage patients to get a blood sugar meter (most have them anyway) and encourage them to test post-prandial levels to better learn what may be causing the problem. I have had only 2-3 patients complain of this problem and most problems resolved with adherence to diet guidelines for hypoglycemia. Hope this is useful. Laschkewitsch RD LDDietitian, Legacy Obesity Institute(503) 413-8135 -----Original Message-----From: [mailto: ]On Behalf Of HegmannSent: Thursday, May 11, 2006 8:15 AM Subject: NESIDIOBLASTOSIS Does anyone have experiences with RNY-related nesidioblastosis? Is anyone using any protocol to screen their hypoglycemic pts for this? Do I correctly assume that if dietary changes don't help those with post op RNY-related hypoglycemia, that an endocrine consult is the next step? Hegmann, MSRD, LDN 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 May 11, 2006 Report Share Posted May 11, 2006 Rare Complication Leaves Gastric Bypass Patients Almost Disabled ROCHESTER, Minn., July 21-A rare complication of gastric bypass surgery leaves its victims virtually disabled, Mayo Clinic researchers here reported today. But others said the complication, called nesidioblastosis, a hyperfunction of insulin-producing beta cells, may also point the way to new treatments for diabetes. The complication leads to a potentially life-threatening deficiency of sucrose in the central nervous system, says Fred Service, M.D., a Mayo endocrinologist and colleagues reported in the July 21 issue of the New England Journal of Medicine. They described six patients who were referred to Mayo between 2000 and 2004 because of severe neurological symptoms -- including confusion and loss of consciousness -- after eating. The symptoms were so severe, Dr. Service said in an interview, that patients couldn't drive or work, and " had to be babysat " for fear they could have a potentially deadly episode. The diagnosis was hypoglycemia, caused by excess insulin production, leading to a severe deficiency of glucose in the central nervous system (i.e., neuroglycopenia). One patient had insulin-producing pancreatic tumors that were surgically removed, but the rest had enlarged and overactive islets without cancer. The mean size was significantly larger than in obese controls (214 micrometers versus 151, p=0.001). When the first patient was referred, the researchers considered the Roux-en-Y gastric bypass to be coincidental, especially because the patient also had insulin-producing pancreatic tumors. But " subsequent experience…led us to raise the possibility of a link between the islet hyperfunction and the bypass surgery, " Dr. Service and colleagues wrote. Over the same time period, nine people who had not had gastric bypass surgery were shown to have nesidioblastosis at the Mayo Clinic, meaning that the gastric bypass patients formed 40% of the total caseload. However, only about a tenth of 1% of the U.S. population has had a gastric bypass. The treatment was partial removal of the pancreas, Dr. Service said, which appeared to ameliorate the problem in all but one of the patients. That patient had a recurrence of symptoms, possibly because not enough of his pancreas was removed. The cause of the nesidioblastosis is less clear, but it seems " possible that beta-trophic factors may be brought into play after bypass surgery, " causing the growth of beta cells and islets, excess insulin production, and post-meal hypoglycemia, the authors argued. " There is some scientific evidence that gut hormones could be mediating this, " Dr. Service said. If that's the case, said University of Washington endocrinologist Cummings, M.D., in an accompanying editorial, it should spur research to identify the mediators " so that their physiological effects can be harnessed " against diabetes. " On the face of it, the paper is a report of a novel adverse consequence of gastric bypass surgery, " Dr. Cummings said in an interview, adding that the condition remains quite rare. " It's hardly a public health crisis. " One of the effects of gastric bypass surgery is to cure type 2 diabetes, he said, and it may be that " the same physiology is melting away the diabetes most of the time and occasionally goes too far. " He added, " I see this a hopeful finding that there's something about gastric bypass surgery that causes beta cells to regrow -- and rarely overgrow -- and if we can find that thing we have the potential of bottling it and using it treat diabetes. " Dr. Service said he's not entirely comfortable with that view: " I think Dr. Cummings may be looking at this through rose-colored glasses. " If there is an upside to the finding, he said, it's that surgeons who perform Roux-en-Y surgery will be alerted to the possibility of nesidioblastosis in their patients. " The follow-up of (gastric bypass surgery) patients hasn't been as assiduous as it should have been, " Dr. Service said. He said the symptoms should not be mistaken for those of the so- called " dumping syndrome " -- flushing, dizziness, profuse sweating, and weakness -- that is commonly seen in gastric bypass patients. > > Does anyone have experiences with RNY-related nesidioblastosis? Is anyone > using any protocol to screen their hypoglycemic pts for this? Do I correctly > assume that if dietary changes don't help those with post op RNY- related > hypoglycemia, that an endocrine consult is the next step? > > Hegmann, MSRD, LDN > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2006 Report Share Posted July 25, 2006 are you able to send the articles via email? if so, would you please send it to me: JAT8780@... THANK YOU!!! > > Nazy, > > We just had 1 pt diagnosed with nesidioblastosis. I can fax you articles if you give me your # !! > > Strathdee, RD, LD, LMHC > Genesis Medical Center > Davenport, IA > 563-421-8361 ( phone ) > > >>> Nazy.Zarshenas@... 7/24/2006 8:18 PM >>> > > Hi all, > has anyone had any patients with nesidioblastosis? T2DM patients who experience severe hypos post prandial, post RYGB. > She is 8/12 post op and gets the symptoms fasting as well as post prandial. never had insulin. We are still doing the definitive diagnosis for these patient. > She is on 4% Glucose infusion and orally we are trailing low GI, frequent CHO meals. Any recommendation will be appreciated. > Many thanks > Regards > Nazy > > > > SOUTH EASTERN SYDNEY AND ILLAWARRA AREA HEALTH SERVICE CONFIDENTIALITY NOTICE > > NB: *** Due to an organisational amalgamation, email addresses for recipients in this organisation have changed. Please update your contacts list with the details of the email addresses contained within. > > This email, and the files transmitted with it, are confidential and intended solely for the use of the individual or entity to whom they are addressed.. If you are not the intended recipient, you are not permitted to distribute or use this email or any of its attachments in any way. We also request that you advise the sender of the incorrect addressing. > > This email message has been virus-scanned. Although no computer viruses were detected, South Eastern Sydney and Illawarra Area Health Service accept no liability for any consequential damage resulting from email containing any computer viruses. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2006 Report Share Posted July 25, 2006 Unfortunately, I can't email them. Do you have a fax ? >>> JAT8780@... 7/25/2006 11:05 AM >>> are you able to send the articles via email? if so, would you please send it to me: JAT8780@... THANK YOU!!! > > Nazy, > > We just had 1 pt diagnosed with nesidioblastosis. I can fax you articles if you give me your # !! > > Strathdee, RD, LD, LMHC > Genesis Medical Center > Davenport, IA > 563-421-8361 ( phone ) > > >>> Nazy.Zarshenas@... 7/24/2006 8:18 PM >>> > > Hi all, > has anyone had any patients with nesidioblastosis? T2DM patients who experience severe hypos post prandial, post RYGB. > She is 8/12 post op and gets the symptoms fasting as well as post prandial. never had insulin. We are still doing the definitive diagnosis for these patient. > She is on 4% Glucose infusion and orally we are trailing low GI, frequent CHO meals. Any recommendation will be appreciated. > Many thanks > Regards > Nazy > > > > SOUTH EASTERN SYDNEY AND ILLAWARRA AREA HEALTH SERVICE CONFIDENTIALITY NOTICE > > NB: *** Due to an organisational amalgamation, email addresses for recipients in this organisation have changed. Please update your contacts list with the details of the email addresses contained within. > > This email, and the files transmitted with it, are confidential and intended solely for the use of the individual or entity to whom they are addressed.. If you are not the intended recipient, you are not permitted to distribute or use this email or any of its attachments in any way. We also request that you advise the sender of the incorrect addressing. > > This email message has been virus-scanned. Although no computer viruses were detected, South Eastern Sydney and Illawarra Area Health Service accept no liability for any consequential damage resulting from email containing any computer viruses. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2006 Report Share Posted July 25, 2006 if you are able to email the articles, i would also like a copy: mindyrauscher@... so much!!!!!!!!! >From: " jat8780 " <JAT8780@...> >Reply- > >Subject: Re: nesidioblastosis >Date: Tue, 25 Jul 2006 16:05:19 -0000 > >are you able to send the articles via email? >if so, would you please send it to me: JAT8780@... > >THANK YOU!!! > > > > > Nazy, > > > > We just had 1 pt diagnosed with nesidioblastosis. I can fax you >articles if you give me your # !! > > > > Strathdee, RD, LD, LMHC > > Genesis Medical Center > > Davenport, IA > > 563-421-8361 ( phone ) > > > > >>> Nazy.Zarshenas@... 7/24/2006 8:18 PM >>> > > > > Hi all, > > has anyone had any patients with nesidioblastosis? T2DM patients >who experience severe hypos post prandial, post RYGB. > > She is 8/12 post op and gets the symptoms fasting as well as post >prandial. never had insulin. We are still doing the definitive >diagnosis for these patient. > > She is on 4% Glucose infusion and orally we are trailing low GI, >frequent CHO meals. Any recommendation will be appreciated. > > Many thanks > > Regards > > Nazy > > > > > > > > SOUTH EASTERN SYDNEY AND ILLAWARRA AREA HEALTH SERVICE >CONFIDENTIALITY NOTICE > > > > NB: *** Due to an organisational amalgamation, email addresses for >recipients in this organisation have changed. Please update your >contacts list with the details of the email addresses contained >within. > > > > This email, and the files transmitted with it, are confidential and >intended solely for the use of the individual or entity to whom they >are addressed.. If you are not the intended recipient, you are not >permitted to distribute or use this email or any of its attachments >in any way. We also request that you advise the sender of the >incorrect addressing. > > > > This email message has been virus-scanned. Although no computer >viruses were detected, South Eastern Sydney and Illawarra Area Health >Service accept no liability for any consequential damage resulting >from email containing any computer viruses. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2006 Report Share Posted July 25, 2006 I can only fax them. If you give me a #, I'll fax. Strathdee >>> mindyrauscher@... 7/25/2006 1:47 PM >>> if you are able to email the articles, i would also like a copy: mindyrauscher@... so much!!!!!!!!! >From: " jat8780 " <JAT8780@...> >Reply- > >Subject: Re: nesidioblastosis >Date: Tue, 25 Jul 2006 16:05:19 -0000 > >are you able to send the articles via email? >if so, would you please send it to me: JAT8780@... > >THANK YOU!!! > > > > > Nazy, > > > > We just had 1 pt diagnosed with nesidioblastosis. I can fax you >articles if you give me your # !! > > > > Strathdee, RD, LD, LMHC > > Genesis Medical Center > > Davenport, IA > > 563-421-8361 ( phone ) > > > > >>> Nazy.Zarshenas@... 7/24/2006 8:18 PM >>> > > > > Hi all, > > has anyone had any patients with nesidioblastosis? T2DM patients >who experience severe hypos post prandial, post RYGB. > > She is 8/12 post op and gets the symptoms fasting as well as post >prandial. never had insulin. We are still doing the definitive >diagnosis for these patient. > > She is on 4% Glucose infusion and orally we are trailing low GI, >frequent CHO meals. Any recommendation will be appreciated. > > Many thanks > > Regards > > Nazy > > > > > > > > SOUTH EASTERN SYDNEY AND ILLAWARRA AREA HEALTH SERVICE >CONFIDENTIALITY NOTICE > > > > NB: *** Due to an organisational amalgamation, email addresses for >recipients in this organisation have changed. Please update your >contacts list with the details of the email addresses contained >within. > > > > This email, and the files transmitted with it, are confidential and >intended solely for the use of the individual or entity to whom they >are addressed.. If you are not the intended recipient, you are not >permitted to distribute or use this email or any of its attachments >in any way. We also request that you advise the sender of the >incorrect addressing. > > > > This email message has been virus-scanned. Although no computer >viruses were detected, South Eastern Sydney and Illawarra Area Health >Service accept no liability for any consequential damage resulting >from email containing any computer viruses. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2006 Report Share Posted July 25, 2006 Thank you all, I have found this article. Fascinating concept. From a nutrition point of view, I have just got her on regular low GI CHO... any other ideas? she still hypos...they are trying Octreotide before the drastic measures of surgery. Nazy Re: nesidioblastosis Nazy, We just had 1 pt diagnosed with nesidioblastosis. I can fax you articles if you give me your # !! Strathdee, RD, LD, LMHC Genesis Medical Center Davenport, IA 563-421-8361 ( phone ) >>> Nazy.Zarshenas@... 7/24/2006 8:18 PM >>> Hi all, has anyone had any patients with nesidioblastosis? T2DM patients who experience severe hypos post prandial, post RYGB. She is 8/12 post op and gets the symptoms fasting as well as post prandial. never had insulin. We are still doing the definitive diagnosis for these patient. She is on 4% Glucose infusion and orally we are trailing low GI, frequent CHO meals. Any recommendation will be appreciated. Many thanks Regards Nazy SOUTH EASTERN SYDNEY AND ILLAWARRA AREA HEALTH SERVICE CONFIDENTIALITY NOTICE NB: *** Due to an organisational amalgamation, email addresses for recipients in this organisation have changed. Please update your contacts list with the details of the email addresses contained within. This email, and the files transmitted with it, are confidential and intended solely for the use of the individual or entity to whom they are addressed.. If you are not the intended recipient, you are not permitted to distribute or use this email or any of its attachments in any way. We also request that you advise the sender of the incorrect addressing. This email message has been virus-scanned. Although no computer viruses were detected, South Eastern Sydney and Illawarra Area Health Service accept no liability for any consequential damage resulting from email containing any computer viruses. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2006 Report Share Posted July 26, 2006 , please fax me a copy when you have time @ 1-203-547-6492 Thank you, Bev Re: nesidioblastosis Nazy,We just had 1 pt diagnosed with nesidioblastosis. I can fax you articles if you give me your # !! Strathdee, RD, LD, LMHCGenesis Medical CenterDavenport, IA 563-421-8361 ( phone )>>> Nazy.ZarshenasSESIAHS (DOT) HEALTH.NSW.GOV.AU 7/24/2006 8:18 PM >>>Hi all,has anyone had any patients with nesidioblastosis? T2DM patients who experience severe hypos post prandial, post RYGB.She is 8/12 post op and gets the symptoms fasting as well as post prandial. never had insulin. We are still doing the definitive diagnosis for these patient.She is on 4% Glucose infusion and orally we are trailing low GI, frequent CHO meals. Any recommendation will be appreciated.Many thanksRegardsNazySOUTH EASTERN SYDNEY AND ILLAWARRA AREA HEALTH SERVICE CONFIDENTIALITY NOTICENB: *** Due to an organisational amalgamation, email addresses for recipients in this organisation have changed. Please update your contacts list with the details of the email addresses contained within.This email, and the files transmitted with it, are confidential and intended solely for the use of the individual or entity to whom they are addressed.. If you are not the intended recipient, you are not permitted to distribute or use this email or any of its attachments in any way. We also request that you advise the sender of the incorrect addressing.This email message has been virus-scanned. Although no computer viruses were detected, South Eastern Sydney and Illawarra Area Health Service accept no liability for any consequential damage resulting from email containing any computer viruses. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2006 Report Share Posted July 26, 2006 Could I also have a copy faxed whenever you get time. Please put ATTN: Fax: 508-595-2941 Thanks On 7/26/06, Bevlyann <bevlyann@...> wrote: , please fax me a copy when you have time @ 1-203-547-6492 Thank you, Bev Re: nesidioblastosis Nazy,We just had 1 pt diagnosed with nesidioblastosis. I can fax you articles if you give me your # !! Strathdee, RD, LD, LMHCGenesis Medical CenterDavenport, IA 563-421-8361 ( phone ) >>> Nazy.Zarshenas@... 7/24/2006 8:18 PM >>>Hi all,has anyone had any patients with nesidioblastosis? T2DM patients who experience severe hypos post prandial, post RYGB.She is 8/12 post op and gets the symptoms fasting as well as post prandial. never had insulin. We are still doing the definitive diagnosis for these patient. She is on 4% Glucose infusion and orally we are trailing low GI, frequent CHO meals. Any recommendation will be appreciated.Many thanksRegardsNazySOUTH EASTERN SYDNEY AND ILLAWARRA AREA HEALTH SERVICE CONFIDENTIALITY NOTICE NB: *** Due to an organisational amalgamation, email addresses for recipients in this organisation have changed. Please update your contacts list with the details of the email addresses contained within.This email, and the files transmitted with it, are confidential and intended solely for the use of the individual or entity to whom they are addressed.. If you are not the intended recipient, you are not permitted to distribute or use this email or any of its attachments in any way. We also request that you advise the sender of the incorrect addressing. This email message has been virus-scanned. Although no computer viruses were detected, South Eastern Sydney and Illawarra Area Health Service accept no liability for any consequential damage resulting from email containing any computer viruses. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2006 Report Share Posted July 26, 2006 I would appreciate a copy Fax 717-948-0488 attn Janelle Janelle D. McLeod, RDGastric Bypass CoordinatorPenn State Hershey Medical Center717-531-6321 This message (including any attachments) contains information intended for a specific individual(s) and purpose that may be privileged, confidential or otherwise protected from disclosure pursuant to applicable law. Any inappropriate use, distribution or copying of the message is strictly prohibited and may subject you to criminal or civil penalty. If you have received this transmission in error, please reply to the sender indicating this error and delete the transmission from your system immediately. >>> "Bevlyann" <bevlyann@...> 7/26/2006 9:05 AM >>> , please fax me a copy when you have time @ 1-203-547-6492 Thank you, Bev Re: nesidioblastosis Nazy,We just had 1 pt diagnosed with nesidioblastosis. I can fax you articles if you give me your # !! Strathdee, RD, LD, LMHCGenesis Medical CenterDavenport, IA 563-421-8361 ( phone )>>> Nazy.ZarshenasSESIAHS (DOT) HEALTH.NSW.GOV.AU 7/24/2006 8:18 PM >>>Hi all,has anyone had any patients with nesidioblastosis? T2DM patients who experience severe hypos post prandial, post RYGB.She is 8/12 post op and gets the symptoms fasting as well as post prandial. never had insulin. We are still doing the definitive diagnosis for these patient.She is on 4% Glucose infusion and orally we are trailing low GI, frequent CHO meals. Any recommendation will be appreciated.Many thanksRegardsNazySOUTH EASTERN SYDNEY AND ILLAWARRA AREA HEALTH SERVICE CONFIDENTIALITY NOTICENB: *** Due to an organisational amalgamation, email addresses for recipients in this organisation have changed. Please update your contacts list with the details of the email addresses contained within.This email, and the files transmitted with it, are confidential and intended solely for the use of the individual or entity to whom they are addressed.. If you are not the intended recipient, you are not permitted to distribute or use this email or any of its attachments in any way. We also request that you advise the sender of the incorrect addressing.This email message has been virus-scanned. Although no computer viruses were detected, South Eastern Sydney and Illawarra Area Health Service accept no liability for any consequential damage resulting from email containing any computer viruses. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2006 Report Share Posted July 26, 2006 Has anyone ever tried cornstarch in milk? The commercially marketed bars containing cornstarch? We currently have a patient who reports that she had a RGBP 4 years ago and is having severe hypoglycemia and has been dx w/nesid. She also reports sx of steatorrhea (does not know how long her limb is). She has never had maldigestion work up. She has gained wt despite modest calorie intake (even accounting for snacks), but her activity level is greatly curtailed. (?related to the hyperinsulin). She has been consuming a high protein fairly high fat diet because her MD told her to " strictly limit carbs " . The only source of carbs in her diet seem to be milk and yogurt, berries and Extend Bars. Do you think she needs to have a little more carb consumption with the focus on glycemic load? She is receiving octreotide injections several times per day. Thanks, Sue ---- <lauramorr@...> wrote: > Could I also have a copy faxed whenever you get time. Please put ATTN: > Fax: 508-595-2941 > Thanks > > > On 7/26/06, Bevlyann <bevlyann@...> wrote: > > > > , please fax me a copy when you have time @ 1-203-547-6492 > > > > Thank you, Bev > > > > > > * Re: nesidioblastosis > > > > > > > > Nazy, > > > > We just had 1 pt diagnosed with nesidioblastosis. I can fax you articles > > if you give me your # !! > > > > Strathdee, RD, LD, LMHC > > Genesis Medical Center > > Davenport, IA > > 563-421-8361 ( phone ) > > > > >>> Nazy.Zarshenas@... 7/24/2006 8:18 PM >>> > > > > Hi all, > > has anyone had any patients with nesidioblastosis? T2DM patients who > > experience severe hypos post prandial, post RYGB. > > She is 8/12 post op and gets the symptoms fasting as well as post > > prandial. never had insulin. We are still doing the definitive diagnosis for > > these patient. > > She is on 4% Glucose infusion and orally we are trailing low GI, frequent > > CHO meals. Any recommendation will be appreciated. > > Many thanks > > Regards > > Nazy > > > > SOUTH EASTERN SYDNEY AND ILLAWARRA AREA HEALTH SERVICE CONFIDENTIALITY > > NOTICE > > > > NB: *** Due to an organisational amalgamation, email addresses for > > recipients in this organisation have changed. Please update your contacts > > list with the details of the email addresses contained within. > > > > This email, and the files transmitted with it, are confidential and > > intended solely for the use of the individual or entity to whom they are > > addressed.. If you are not the intended recipient, you are not permitted to > > distribute or use this email or any of its attachments in any way. We also > > request that you advise the sender of the incorrect addressing. > > > > This email message has been virus-scanned. Although no computer viruses > > were detected, South Eastern Sydney and Illawarra Area Health Service accept > > no liability for any consequential damage resulting from email containing > > any computer viruses. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 27, 2006 Report Share Posted July 27, 2006 IT seems to me that no carbohydrates would not help the situation, having some would seem to elevate the blood sugar and help prevent the lows. Paying attention to GI/fiber/simple carbs etc would probably be useful but to "strictly limit carbs" does not seem appropriate to me. Blood sugar meters are really the true thing to rely on though...food and blood sugar records together for 2 weeks may be very helpful. Have her try a few days with more carbs and see what happens. Laschkewitsch RD Legacy Obesity Institute Portland OR Re: nesidioblastosis Has anyone ever tried cornstarch in milk? The commercially marketed bars containing cornstarch? We currently have a patient who reports that she had a RGBP 4 years ago and is having severe hypoglycemia and has been dx w/nesid. She also reports sx of steatorrhea (does not know how long her limb is). She has never had maldigestion work up. She has gained wt despite modest calorie intake (even accounting for snacks), but her activity level is greatly curtailed. (?related to the hyperinsulin). She has been consuming a high protein fairly high fat diet because her MD told her to "strictly limit carbs". The only source of carbs in her diet seem to be milk and yogurt, berries and Extend Bars. Do you think she needs to have a little more carb consumption with the focus on glycemic load? She is receiving octreotide injections several times per day.Thanks, Sue---- <lauramorrgmail> wrote: > Could I also have a copy faxed whenever you get time. Please put ATTN: > Fax: 508-595-2941> Thanks> > > On 7/26/06, Bevlyann <bevlyanncomcast (DOT) net> wrote:> >> > , please fax me a copy when you have time @ 1-203-547-6492> >> > Thank you, Bev> >> >> > * Re: nesidioblastosis> >> >> >> > Nazy,> >> > We just had 1 pt diagnosed with nesidioblastosis. I can fax you articles> > if you give me your # !!> >> > Strathdee, RD, LD, LMHC> > Genesis Medical Center> > Davenport, IA> > 563-421-8361 ( phone )> >> > >>> Nazy.ZarshenasSESIAHS (DOT) HEALTH.NSW.GOV.AU 7/24/2006 8:18 PM >>>> >> > Hi all,> > has anyone had any patients with nesidioblastosis? T2DM patients who> > experience severe hypos post prandial, post RYGB.> > She is 8/12 post op and gets the symptoms fasting as well as post> > prandial. never had insulin. We are still doing the definitive diagnosis for> > these patient.> > She is on 4% Glucose infusion and orally we are trailing low GI, frequent> > CHO meals. Any recommendation will be appreciated.> > Many thanks> > Regards> > Nazy> >> > SOUTH EASTERN SYDNEY AND ILLAWARRA AREA HEALTH SERVICE CONFIDENTIALITY> > NOTICE> >> > NB: *** Due to an organisational amalgamation, email addresses for> > recipients in this organisation have changed. Please update your contacts> > list with the details of the email addresses contained within.> >> > This email, and the files transmitted with it, are confidential and> > intended solely for the use of the individual or entity to whom they are> > addressed.. If you are not the intended recipient, you are not permitted to> > distribute or use this email or any of its attachments in any way. We also> > request that you advise the sender of the incorrect addressing.> >> > This email message has been virus-scanned. Although no computer viruses> > were detected, South Eastern Sydney and Illawarra Area Health Service accept> > no liability for any consequential damage resulting from email containing> > any computer viruses.> >> > > > 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...
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