Perioperative glycaemic control in insulin-treated type 2 diabetes patients undergoing gastric bypass surgery.
BACKGROUND
Roux-and-Y gastric bypass (RYGB) rapidly reduces insulin requirements in patients with insulin-dependent type 2 diabetes mellitus (T₂DMi). A too modest reduction in insulin dose may lead to hypoglycaemia in the early postoperative period.


OBJECTIVE
To evaluate a regimen designed to maintain blood glucose levels between 5-15 mmol/l and to prevent hypoglycaemic events (blood glucose <3.5 mmol/l) after RYGB surgery.


METHODS
The effect of a 75% reduction in insulin dose was studied in 85 T₂DMi patients during the first ten days after RYGB. Patients with severe b-cell failure (fasting C-peptide <0.3 nmol/l) were excluded.


METHODS
percentage of patients exceeding the upper or lower blood glucose limits, and the number of hypoglycaemic events.


RESULTS
The mean blood glucose level was 12.4±0.3 mmol/l (mean ± SE) on the day of surgery (day 0), 10.7±0.3 mmol/l on day 1, 10.0±0.5 mmol/l on day 2, and 8.3±0.3 on day 10. Of all measurements performed during this ten-day period, 12.4% were above the target range, and 2.6% were <5 mmol/l. There were no hypoglycaemic events during the stay in hospital. During the first week at home 2% of the measurements were <3.5 mmol/l.


CONCLUSIONS
A 75% reduction in insulin dose is safe in T₂DMi patients without severe b-cell failure, and prevents hypoglycaemia in the early postoperative period of RYGB in most cases.
Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands.
M
M
Cruijsen
P
P
Koehestani
S
S
Huttjes
K
K
Leenders
I
I
Janssen
H
H
de Boer
D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D059035:Perioperative Period; D013997:Time Factors
D001786:Blood Glucose; D002096:C-Peptide; D007004:Hypoglycemic Agents; D007328:Insulin; D005947:Glucose