Medical nutrition therapy for post-bariatric hypoglycemia: practical insights

Abstract

Hypoglycemia is increasingly recognized as a complication of bariatric surgery. Although medications are often required, medical nutrition therapy remains the key cornerstone for successful prevention of hypoglycemia in patients with post-bariatric hypoglycemia (PBH). We provide suggested approaches to the dietary management of PBH, incorporating data from both the medical literature and extensive clinical experience in an academic referral center for PBH. The overall goal of medical nutrition therapy for PBH is to reduce postprandial surges in glucose, which often trigger surges in insulin secretion and promote subsequent hypoglycemia. Thus, strategies focus on controlled portions of low glycemic index carbohydrates, avoidance of rapidly-absorbed carbohydrates, adjustment of timing of meals and snacks, and attention to personal and cultural barriers to implementation.

Keywords: Bariatric surgery; Hypoglycemia; Medical nutrition therapy.

Figure 1

Typical patterns of glucose in the fasting state and after a meal in patients with PBH, as revealed by continuous glucose monitoring. In this patient, glucose levels are stable during the overnight fast.