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Hipoglucemia post by pass gástrico
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Transcript

  • 1. Hypoglycemia after GBP 10 min V Congreso Internacional de Cirugia Bariatrica y Metabolica Mendoza Argentina May 19 & 20, 2011
  • 2. 0.2% incidence of admission for hypoglycemia
  • 3. Molecular mechanisms that lead to congenital hyperinsulinemic hypoglycemia
  • 4. Mechanisms of action
    • Dumping syndrome: ↑ insulin secretion
    • ↑ insulin sensitivity unmasking familial hyperinsulinemia
    • Lack of regression of β-cell mass
    • GLP1-mediated active expansion of β-cell mass
  • 5.  
  • 6.  
  • 7.  
  • 8. Medical Management
    • Dietary optimization
    • Diazoxide
    • Octreotide
    • Calcium channel blocker
    • Acarbose
  • 9. Surgical Options
    • Increase restriction
    • Reversal
    • Revision
    • Pancreatectomy
  • 10.  
  • 11. Pancreatectomy Mayo 6 patients 3 cured 2 occasional sx 1 more severe sx Indiana 9 patients 2 cured 3 occasional sx 2 medical tx 2 refractory G. Service, MD V. Mathavan, MD 2 patients developed DM
  • 12.