title: Evaluation of carbohydrate restriction as primary treatment for post-gastric bypass hypoglycemia.
abstract: Up to 15% of patients who have undergone Roux-en-Y gastric bypass (RYGB) surgery may eventually develop symptoms of hypoglycemia.
  
  
  
  To evaluate the daily life efficacy of a carbohydrate (carb)-restricted dietary advice (CRD) of 6 meals per day with a 30 g carb maximum per meal in patients with documented post-RYGB hypoglycemia.
  
  
  
  Teaching hospital, the Netherlands.
  
  
  
  Frequency and severity of hypoglycemic events before and after CRD were assessed retrospectively in 41 patients with documented post-RYGB hypoglycemia, based on medical records and telephone questionnaires. Hypoglycemia was defined as a blood glucose level<3.0 mmol/L. Results are expressed as mean values±standard error or median and range.
  
  
  
  CRD decreased the number of hypoglycemic events per month from 17.1 (1.5-180) to 2.5 (0-180), i.e., a decline of 85% (P<.001). The lowest blood glucose measured during a hypoglycemic event increased from 2.1±.4 to 2.6±.2 mmol/L (P = .004). The number of patients who had required outside help in the treatment of hypoglycemia, decreased from 23 to 6 (P<.001). In 14 patients (34.1%) the diet-induced reduction of hypoglycemia was insufficient and required the start of insulin suppressive therapy.
  
  
  
  A CRD, consisting of 6 meals per day with up to 30 g carbs each, is an effective treatment of post-RYGB hypoglycemia in the majority of patients. Additional medication is needed in about a third of patients.
authors.affiliation: Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands. Electronic address: jorickvm@gmail.com.
authors.forename: Jorick
authors.initials: J
authors.lastname: van Meijeren
authors.affiliation: Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: Ilse
authors.initials: I
authors.lastname: Timmer
authors.affiliation: Department of Clinical Nutrition, Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Brandts
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: Ignace
authors.initials: I
authors.lastname: Janssen
authors.affiliation: Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: Hans de
authors.initials: H
authors.lastname: Boer
mesh_terms: D000203:Activities of Daily Living; D001786:Blood Glucose / Q000378:metabolism; D050528:Diet, Carbohydrate-Restricted; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000178:diet therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000097:blood / Q000178:diet therapy / Q000209:etiology; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose
keywords: Carbohydrate restriction; Daily life efficacy; Hypoglycemia; Roux-en-Y gastric bypass