January 5, 2006
Hypoglycemia, Nesidioblastosis
Question from California, USA:
I have a question about nesidioblastosis. I had gastric bypass surgery 13 months ago. I have lost 161 pounds and I am now at a healthy weight. I had several problems after my surgery, including being put on a TPN Bag for over two months and hospitalization for low electrolyte levels, among other things.
Last May, I felt a lump in my throat so I went to my doctor, who ran tests over a five month period. I was sent to an endocrinologist who told me I had Hashimoto’s disease. Things progressed from there. I had a nuclear thyroid scan which showed I have hyperthyroidism and possibly had Graves Disease as well. Things from here just keep getting worse. I started having low blood sugar levels, usually in the low 40s mg/dl [2.2 to 2.5 mmol/L]. I was always hypoglycemic prior to my gastric bypass, but was told to control it by eating several small meals during the day. I was extremely overweight. Eating wasn’t the problem, but I still suffered from the low blood sugars. Recently, things have gotten much worse. I’ve had dizzy spells, headaches, lightheadedness, nervousness, heart palpitations, and shaking. I am going to see a doctor at USC Medical Center, but I would like to get some extra information about the above listed condition. I spoke to a good friend, who is a nurse and also had the gastric bypass surgery. She sent me the information on it. Now, I am really scared. I want to feel better and get this taken care of. Can you help me with any information at all? I would greatly appreciate anything you can do.
Answer:
The presence of nesidioblastosis following gastric bypass surgery is a relatively new observation. I think of it as a problem of transitioning from the old body to the new body. When you weighed a lot more, your body was very resistant and you had to make increased amounts of insulin to compensate. Now, in a short time, your body is rid of the fat, your insulin resistance is low, and you do not need the increased insulin production that your body previously needed. There is also the issue that changing the gut physiology may affect hormones that interact with insulin secretion and may induce some of these changes. In the patients that continued to have severe symptoms, they were treated with surgery to reduce the mass of the functioning islet tissue in order to decrease insulin production. I am glad you are going to see someone who is familiar with this. They will probably end up doing stimulation testing to see how responsive your pancreas is in its production of insulin to a challenge.
JTL
