216. Glucose Gone Wild: Glycemic Challenges Surrounding Metabolic Surgery

Sunday, October 27
1:30 PM – 3:00 PM
Location: 113-ABC
CE: 1.5
Level 3 – Advanced
Activity Code: 149426

Metabolic surgeries, such as duodenal switch, gastric bypass, and sleeve gastrectomy, have earned a place in the American Diabetes Association treatment algorithm for type 2 diabetes due to their proven efficacy in improving glucose homeostasis and ability to facilitate remission of diabetes. However, the challenges of diabetes remain before and after surgery. Before surgery, achievement of glycemic targets, weight loss requirements, and low carbohydrate preoperative diets increase risk for hypoglycemia. Immediately after surgery, rapid changes in gut hormones, limited oral nutrition, and medication adjustments can lead to a roller coaster of glucose levels. Some patients progress to face the challenge of long-term multifactorial hypoglycemia, requiring a complex work-up for etiology. Join us for case-based learning to detect and manage the glycemic challenges of metabolic surgery.

Learning Objectives:

  • Identify elements of the pre- and postoperative care protocols for metabolic surgery that present risk for hypo- and hyperglycemia in patients with diabetes.
  • Apply management strategies for hypo- and hyperglycemia in the context of metabolic surgery protocols.
  • Describe the work-up and treatment pathways for a patient experiencing hyperinsulinemic hypoglycemia after metabolic surgery.

Learning Need Codes:

  • 5190 Diabetes mellitus (disease/disorder)
  • 5125 Bariatric Surgery
  • 2110 Physiology, exercise physiology

Performance Indicator:

  • 8.2.4 Imparts knowledge of the importance of physical activity and applies behavior change principles to promote physical activity and decrease inactivity.
  • 8.3.6 Keeps abreast of current nutrition and dietetics knowledge and trends.


  • Meghan Ariagno, RD, CSOWM, CDE

    Bariatric Program Manager

    Brigham and Women’s Hospital

  • Speaker(s)

  • Mary Elizabeth Patti, MD, FACP

    Endocrinologist, Director of the Hypoglycemia Clinic

    Joslin Diabetes Center

  • Laura Andromalos, MS, RD, CSOWM, CDE

    Nutrition Program Manager

    Northwest Weight & Wellness Center