Post-Bariatric Hypoglycemia: Complicating Factors and Practical Approaches to Nutritional Care

Bariatric surgery can achieve significant weight loss and lead to remission of medical conditions, including type 2 diabetes for some. Therefore, the number of bariatric surgeries performed increases yearly. However, with this metabolic success comes the risk of hypoglycemia, termed post-bariatric hypoglycemia (PBH). PBH is important to consider when performing a nutrition assessment for individuals who have a history of bariatric surgery and other upper gastrointestinal surgeries. PBH may not emerge for one or more years after surgery, and while some symptoms overlap with dumping syndrome, the severe and recurrent low glucose levels of PBH are distinct in terms of timing and pathophysiology. Individuals may experience changes in cognition, loss of consciousness, and even seizures. Medical nutrition therapy is the foundational treatment approach. You will walk away from this session with an understanding of PBH risk factors, etiology, workup, treatment, prescriptive MNT guidelines, and ongoing monitoring of response to MNT, as well as ways to address barriers to care to individualize your approach to MNT.

CPE Level: Level 2 (intermediate knowledge/experience)
CPEU: 1.5

Performance Indicators

• 10.1.3 Compares nutrition screening results with normative references in order to determine nutrition risks to individuals.
• 8.1.4 Integrates knowledge of macro- and micronutrients for digestion, absorption and metabolism throughout the lifespan in practice.
• 10.5.2 Monitors and identifies factors affecting client/patient progress in meeting goals.

Learning Objectives

• Identify etiology, risk factors and symptoms characteristic of post -bariatric hypoglycemia in order to aide in prompt referral for medical evaluation
• Examine cognitive, cultural, economic and psychosocial challenges to PBH management in order to address barriers to care and individualize treatment approach
• Design dietary intervention to optimize glycemic stability in order to reduce risk of hypoglycemia

Moderator

• Sandra Arevalo, MPH, RDN, CDN, CDE, FADA

Speakers

• Nicole Patience, MS RD, LDN, CDCES, CEDRD-S
• Amanda L. Sheehan, MSN, FNP-BC, NP-C, RN