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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.
Surg Obes Relat Dis. 2014 Nov-Dec; 10(6):1047-54.SO

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+Show Affiliations

Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Sweden. Electronic address: anna.laurenius@vgregion.se.Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Sweden.Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Sweden; Diabetes Complications Research Centre, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Ireland.Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Sweden.Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Sweden.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25205571

Citation

Laurenius, Anna, et al. "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." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 10, no. 6, 2014, pp. 1047-54.
Laurenius A, Werling M, Le Roux CW, et al. 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. Surg Obes Relat Dis. 2014;10(6):1047-54.
Laurenius, A., Werling, M., Le Roux, C. W., Fändriks, L., & Olbers, T. (2014). 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. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 10(6), 1047-54. https://doi.org/10.1016/j.soard.2014.04.007
Laurenius A, et al. 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. Surg Obes Relat Dis. 2014 Nov-Dec;10(6):1047-54. PubMed PMID: 25205571.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Laurenius,Anna, AU - Werling,Malin, AU - Le Roux,Carel W, AU - Fändriks,Lars, AU - Olbers,Torsten, Y1 - 2014/04/18/ PY - 2014/01/10/received PY - 2014/03/27/revised PY - 2014/04/09/accepted PY - 2014/9/11/entrez PY - 2014/9/11/pubmed PY - 2015/9/10/medline KW - Blood pressure KW - Dumping syndrome KW - Glucagon KW - Glucagon-like peptide 1 KW - Glucose KW - Hypoglycemia KW - Insulin KW - Pulse KW - Roux-en-Y gastric bypass SP - 1047 EP - 54 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 10 IS - 6 N2 - 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. SN - 1878-7533 UR - https://www.unboundmedicine.com/medline/citation/25205571/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(14)00156-7 DB - PRIME DP - Unbound Medicine ER -