More symptoms but similar blood glucose curve after oral carbohydrate provocation in patients with a history of hypoglycemia-like symptoms compared to asymptomatic patients after Roux-en-Y gastric bypass.

Abstract

BACKGROUND:

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective treatment for obesity through altering several physiologic mechanisms. Some patients experience symptoms suggestive of hypglycemia after LRYGB, but whether these symptoms always are associated with low blood glucose are unclear. The objective of this study was to investigate the correlation between symptoms suggestive of hypglycemia, plasma glucose levels and gut hormones involved in glycemic control.

METHODS:

Eight LRYGB patients with hypglycemia-like symptoms (SY) and 8 patients with no hypglycemia-like symptoms (ASY) ingested a liquid carbohydrate meal. Insulin, plasma-glucose, glucagon-like peptide 1 (GLP-1) and glucagon were measured intermittently 180 minutes postprandially. In addition, pulse rate, blood pressure and symptoms were assessed.

RESULTS:

Plasma glucose at 120 min was lower in the ASY mean (95% CI) 2.4 (1.6,3.3) mmol/L (43.2 mg/dL) compared to the SY group 3.0 (3.1,4.6) mmol/L (54.6 mg/dL), (P = .050). The ASY group had larger reduction in plasma glucose than the SY group from pre- to 120 min postmeal -2.2 (-2.8,-1.7) mmol/L (-39.6 mg/dL) versus -1.1 (-1.7,-0.4) mmol/L (-19.8 mg/dL), (P = .011). The concentrations of insulin, GLP-1 and glucagon did not differ significantly between groups. Blood pressure was similar between groups, but the AUC for pulse rate was higher in the SY than ASY group 13009 (11148,14870) versus 11569 (10837,12300) beats/180 minutes, (P = .038). The SY group reported more symptoms than the ASY group, AUC for Sigstad scale 60 to 180 minutes was 970 (-274,1667) for SY versus 170 for ASY (-39,379), (P = .028).

CONCLUSION:

Patients with a history of symptoms suggestive of hypglycemia after LRYGB neither demonstrated lower plasma glucose nor greater insulin response compared to asymptomatic patients in response to a liquid carbohydrate meal, but perceived more symptoms.

• Authors: Anna Laurenius, Malin Werling, Carel W Le Roux, Lars Fändriks, Torsten Olbers
• Journal: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Surg Obes Relat Dis) 2014 Nov-Dec Vol. 10 Issue 6 Pg. 1047-54 ISSN: 1878-7533 [Electronic] United States
• PMID: 25205571 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Chemical References

• Blood Glucose
• Carbohydrates
• Glucagon-Like Peptide 1

Topics

• Administration, Oral
• Adult
• Blood Glucose (analysis)
• Blood Pressure Determination
• Body Mass Index
• Carbohydrates
• Case-Control Studies
• Female
• Gastric Bypass (adverse effects, methods)
• Glucagon-Like Peptide 1 (blood)
• Glucose Tolerance Test (methods)
• Heart Rate
• Humans
• Hypoglycemia (diagnosis, epidemiology)
• Male
• Middle Aged
• Obesity, Morbid (diagnosis, surgery)
• Postoperative Complications (diagnosis, epidemiology)
• Preoperative Care
• Prevalence
• Reference Values
• Risk Assessment
• Statistics, Nonparametric