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Glucose-stimulated insulin secretion in gastric bypass patients with hypoglycemic syndrome: no evidence for inappropriate pancreatic beta-cell function.

AbstractBACKGROUND:
Roux-en-Y gastric bypass surgery (RYGB) has been associated with a hypoglycemic syndrome characterized by postprandial hypoglycemia and hyperinsulinemia. The syndrome is believed to occur due to insulin hypersecretion from either pancreatic beta-cell hyperplasia or hyperfunction.
METHODS:
Eight RYGB patients with hypoglycemic syndrome had insulin secretion rates determined during a 240-min graded intravenous glucose infusion. They were compared to 34 nondiabetic, nonsurgical individuals who were divided based on their insulin sensitivity status as measured by the insulin suppression test: insulin-sensitive (n = 8), insulin intermediate (n = 7), and insulin-resistant (n = 19).
RESULTS:
RYGB patients had insulin concentrations and HOMA-IR similar to the insulin-sensitive reference group. In addition, integrated insulin secretion rates were comparable to the insulin-sensitive group and significantly lower than the insulin intermediate (p <or= 0.046) and insulin-resistant groups (p <or= 0.001). Pancreatic beta-cell sensitivity to glucose (slope relating glucose and ISR) was lowest in the RYGB group (p <or= 0.04).
CONCLUSIONS:
Patients with hypoglycemic syndrome post-RYGB do not have generalized hypersecretion of insulin and appear to have appropriate insulin secretion rate in response to intravenous glucose.
AuthorsSun H Kim, Fahim Abbasi, Cindy Lamendola, Gerald M Reaven, Tracey McLaughlin
JournalObesity surgery (Obes Surg) Vol. 20 Issue 8 Pg. 1110-6 (Aug 2010) ISSN: 1708-0428 [Electronic] United States
PMID20665189 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
Chemical References
  • Insulin
  • Glucose
Topics
  • Adult
  • Area Under Curve
  • Female
  • Gastric Bypass (adverse effects)
  • Glucose (administration & dosage, metabolism)
  • Humans
  • Hyperinsulinism (etiology)
  • Hypoglycemia (etiology, metabolism)
  • Insulin (metabolism)
  • Insulin Resistance (physiology)
  • Insulin Secretion
  • Insulin-Secreting Cells (physiology)
  • Male
  • Middle Aged
  • Obesity, Morbid (surgery)

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