title: 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).
  
  
  CONCLUSIONS
  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.affiliation: Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Sweden. Electronic address: anna.laurenius@vgregion.se.
authors.forename: Anna
authors.initials: A
authors.lastname: Laurenius
authors.affiliation: Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Werling
authors.affiliation: 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.
authors.forename: Carel W
authors.initials: CW
authors.lastname: Le Roux
authors.affiliation: Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Fändriks
authors.affiliation: Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Torsten
authors.initials: T
authors.lastname: Olbers
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D001795:Blood Pressure Determination; D015992:Body Mass Index; D002241:Carbohydrates; D016022:Case-Control Studies; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D005951:Glucose Tolerance Test / Q000379:methods; D006339:Heart Rate; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011300:Preoperative Care; D015995:Prevalence; D012016:Reference Values; D018570:Risk Assessment; D018709:Statistics, Nonparametric
chemical_list: D001786:Blood Glucose; D002241:Carbohydrates; D052216:Glucagon-Like Peptide 1
keywords: Blood pressure; Dumping syndrome; Glucagon; Glucagon-like peptide 1; Glucose; Hypoglycemia; Insulin; Pulse; Roux-en-Y gastric bypass