title: Hypoglycemia in everyday life after gastric bypass and duodenal switch.
abstract: METHODS
  Gastric bypass (GBP) and duodenal switch (DS) in morbid obesity are accompanied by marked metabolic improvements, particularly in glucose control. In recent years, episodes of severe late postprandial hypoglycemia have been increasingly described in GBP patients; data in DS patients are scarce. We recruited three groups of subjects; 15 GBP, 15 DS, and 15 non-operated overweight controls to examine to what extent hypoglycemia occurs in daily life.
  
  
  METHODS
  Continuous glucose monitoring (CGM) was used during 3 days of normal activity. The glycemic variability was measured by mean amplitude of glycemic excursion and continuous overall net glycemic action. Fasting blood samples were drawn, and the patients kept a food and symptom log throughout the study.
  
  
  RESULTS
  The GBP group displayed highly variable CGM curves, and 2.9% of their time was spent in hypoglycemia (<3.3  mmol/l, or 60  mg/dl). The DS group had twice as much time in hypoglycemia (5.9%) and displayed CGM curves with little variation as well as lower HbA1c levels (29.3 vs 35.9 mmol/mol, P<0.05). Out of a total of 72 hypoglycemic episodes registered over the 3-day period, 70 (97%) occurred in the postprandial state and only about one-fifth of the hypoglycemic episodes in the GBP and DS groups were accompanied by symptoms. No hypoglycemias were seen in controls during the 3-day period.
  
  
  CONCLUSIONS
  Both types of bariatric surgery induce marked, but different, changes in glucose balance accompanied by frequent, but mainly unnoticed, hypoglycemic episodes. The impact and mechanism of hypoglycemic unawareness after weight-reduction surgery deserves to be clarified.
authors.affiliation: Departments of Medical SciencesSurgical SciencesUppsala University Hospital, S-751 85 Uppsala, Sweden niclas.abrahamsson@medsci.uu.se.
authors.forename: Niclas
authors.initials: N
authors.lastname: Abrahamsson
authors.affiliation: Departments of Medical SciencesSurgical SciencesUppsala University Hospital, S-751 85 Uppsala, Sweden.
authors.forename: Britt
authors.initials: B
authors.lastname: Edén Engström
authors.affiliation: Departments of Medical SciencesSurgical SciencesUppsala University Hospital, S-751 85 Uppsala, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Sundbom
authors.affiliation: Departments of Medical SciencesSurgical SciencesUppsala University Hospital, S-751 85 Uppsala, Sweden.
authors.forename: F Anders
authors.initials: FA
authors.lastname: Karlsson
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D018660:Blood Pressure Monitoring, Ambulatory; D015930:Diet Records; D004386:Duodenum / Q000601:surgery*; D004435:Eating; D016099:Endoscopy, Gastrointestinal; D005260:Female; D015390:Gastric Bypass; D006706:Homeostasis; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood; D055815:Young Adult
chemical_list: D001786:Blood Glucose