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The Hypoglycemia Clinic at Joslin

Hypoglycemia is a condition that involves very low blood sugar levels. The team at Joslin recognizes that hypoglycemia can difficult to live with, disabling, and even life threatening. There are many causes of hypoglycemia, even in patients without diabetes including medications and supplements or medical and hormonal conditions. Hypoglycemia can also follow upper gastrointestinal surgery (e.g. stomach or esophagus resection, fundoplication) or bariatric/metabolic surgery  (gastric bypass or sleeve gastrectomy). Other forms of hypoglycemia include reactive hypoglycemia or postprandial hypoglycemia, or rare insulin- or other hormone-producing tumors.

 

Why the Post-Bariatric Hypoglycemia and Hypoglycemia Clinic?

We provide a comprehensive analysis of individuals referred by their physician for evaluation of documented hypoglycemia (low blood sugar) for both diagnostic and treatment needs.

We have expertise in evaluation and management of complex hypoglycemia syndromes in adults, including insulin-producing tumors and hypoglycemia which follows gastrointestinal surgery (e.g. gastric bypass).

You may reccieve opportunities to participate in specialized clinical trials.

Expert staffing comprised of our unique team of providers, including:

  • Dr. Patti, an adult endocrinologist (hormone/metabolism specialist physician).

  • Endocrinology fellow and experienced nurse practitioner who work with Dr. Patti

  • A registered dietitian and certified diabetes educator with expertise in hypoglycemia.

  • Registered nurses and certified diabetes educators.

How do I make an appointment?

We appreciate your interest in having an evaluation at the hypoglycemia clinic at Joslin. All individuals seeking an appointment must be referred by a physician and a complete set of records from the referring physician must be received prior to scheduling an appointment. Additionally, if the referring physician is not an endocrinologist, but you have seen an endocrinologist in the past, these records will need to be received as well prior to scheduling your first visit. This is to ensure that the hypoglycemia team has all of information needed to carefully review your history prior to your appointment, as well as to inform what labs or testing may need to be ordered. Depending on appointment availability, it is possible that your first visit will be with an experienced nurse practitioner; this is to begin the process of evaluation, and you will see Dr. Patti at your next visit. After your initial visit, follow-up will be scheduled as needed. Following evaluation of your hypoglycemia you may be referred back to your endocrinologist for ongoing care. To initiate the appointment process please call 617 309 2440 (appointments office).  

Resources

 

Selected research publications on hypoglycemia authored by the staff of the hypoglycemia clinic - more in progress!

  • 2023:  Dr. Patti reported results of treatment in a single patient with  severe tumor-associated hypoglycemia, using an investigational antibody against the insulin receptor to block the effects of insulin.  This was published in the New England Journal of Medicine (PMID 37611129).

  • 2023:  Dr. Patti and the hypoglycemia research team published results of the use of continuous glucose monitoring, which successfully reduced hypoglycemia and reduced glycemic variability.  This was published in Diabetes, Obesity, and Metabolism (Cummings C et al, PMID 37046360).

  • 2023:  Scientific review of glucose metabolism after bariatric surgery:  implications for type 2 diabetes remission and hypoglycemia (Sandoval DA and Patti ME, Nature Reviews Endocrinology 2023, PMID 36289368).

  • 2022:  Medical nutrition therapy and other approaches to management of post-bariatric hypoglycemia:  a team based approach (Patience N et al, Current Obesity Reports 2022, PMID 36074258).

  • 2022:  Results of a study using pramlintide for post-bariatric hypoglycemia. Sheehan A et al, Diabetes Obesity and Metabolism 2022, PMID 35137513.

  • 2022:  Review of hypoglycemia and dysautonomia (disorder of the autonomic nervous system) after bariatric surgery.  Addison P et al, Obesity Surgery 2022, PMID 35133603.

  • 2021:  Identification of mediators of post-surgical diabetes control.  Dreyfuss JM et al, Nature Communications 2021, PMID 34845204.

  • 2021:  Postbariatric hypoglycemia:  symptom patterns and associated risk factors in the Longitudinal Assessment of Bariatric Surgery study.  Fischer LE et al, Surgery for Obesity and Related Disorders (SOARD) 2021, PMID 34294589.

  • 2020:  Review of post-bariatric hypoglycemia.  Sheehan A et al. Hypoglycemia After Upper Gastrointestinal Surgery: Clinical Approach to Assessment, Diagnosis, and Treatment, published in Diabetes, Metabolic Syndrome, and Obesity 2020, PMID 33239898. 

  • 2018: review of  "Hypoglycemia after Gastric Bypass Surgery" .  Salehi M et al.  Journal of Clinical Endocrinology and Metabolism 2018, PMID 30101281. 

  • 2017:  Our expert dietitian, Emmy Suhl RD, MS, summarizes the critical nutritional approaches to managing this condition. Suhl et al.  SOARD 2017, PMID 28392017. 

  • Article from our hypoglycemia team which describes first steps to developing a glucagon delivery system to prevent hypoglycemia in this setting, information now guiding current ongoing research. Laguna Sanz AJ et al.  Diabetes Technol Ther 2018, PMID 39355439.

  • Article from our hypoglycemia team about further development and testing of a novel glucagon delivery system to prevent hypoglycemia in patients with post-bariatric hypoglycemia.  This study is now guiding further development of a pump system.  Mulla CM et al.  Journal of Clinical Endocrinology and Metabolism 2020, PMID 31714583