title: Postprandial diabetic glucose tolerance is normalized by gastric bypass feeding as opposed to gastric feeding and is associated with exaggerated GLP-1 secretion: a case report.
abstract: OBJECTIVE
  To examine after gastric bypass the effect of peroral versus gastroduodenal feeding on glucose metabolism.
  
  
  METHODS
  A type 2 diabetic patient was examined on 2 consecutive days 5 weeks after gastric bypass. A standard liquid meal was given on the first day into the bypassed gastric remnant and on the second day perorally. Plasma glucose, insulin, C-peptide, glucagon, incretin hormones, peptide YY, and free fatty acids were measured.
  
  
  RESULTS
  Peroral feeding reduced 2-h postprandial plasma glucose (7.8 vs. 11.1 mmol/l) and incremental area under the glucose curve (iAUC) (0.33 vs. 0.49 mmol . l(-1) . min(-1)) compared with gastroduodenal feeding. beta-Cell function (iAUC(Cpeptide/Glu)) was more than twofold improved during peroral feeding, and the glucagon-like peptide (GLP)-1 response increased nearly fivefold.
  
  
  CONCLUSIONS
  Improvement in postprandial glucose metabolism after gastric bypass is an immediate and direct consequence of the gastrointestinal rearrangement, associated with exaggerated GLP-1 release and independent of changes in insulin sensitivity, weight loss, and caloric restriction.
authors.affiliation: Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark. cardir@gmail.com
authors.forename: Carsten
authors.initials: C
authors.lastname: Dirksen
authors.forename: Dorte L
authors.initials: DL
authors.lastname: Hansen
authors.forename: Sten
authors.initials: S
authors.lastname: Madsbad
authors.forename: Lisbeth E
authors.initials: LE
authors.lastname: Hvolris
authors.forename: Lars S
authors.initials: LS
authors.lastname: Naver
authors.forename: Jens J
authors.initials: JJ
authors.lastname: Holst
authors.forename: Dorte
authors.initials: D
authors.lastname: Worm
mesh_terms: D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000601:surgery; D004750:Enteral Nutrition; D005230:Fatty Acids, Nonesterified / Q000097:blood; D015390:Gastric Bypass; D005934:Glucagon / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood / Q000378:metabolism*; D006801:Humans; D054795:Incretins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D019894:Peptide YY / Q000097:blood; D011184:Postoperative Period; D019518:Postprandial Period / Q000502:physiology*
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D005230:Fatty Acids, Nonesterified; D054795:Incretins; D019894:Peptide YY; D052216:Glucagon-Like Peptide 1; D005934:Glucagon