Gastric Bypass Reduces Symptoms and Hormonal Responses in Hypoglycemia.
Gastric bypass (GBP) surgery, one of the most common bariatric procedures, induces weight loss and metabolic effects. The mechanisms are not fully understood, but reduced food intake and effects on gastrointestinal hormones are thought to contribute. We recently observed that GBP patients have lowered glucose levels and frequent asymptomatic hypoglycemic episodes. Here, we subjected patients before and after undergoing GBP surgery to hypoglycemia and examined symptoms and hormonal and autonomic nerve responses. Twelve obese patients without diabetes (8 women, mean age 43.1 years [SD 10.8] and BMI 40.6 kg/m(2) [SD 3.1]) were examined before and 23 weeks (range 19-25) after GBP surgery with hyperinsulinemic-hypoglycemic clamp (stepwise to plasma glucose 2.7 mmol/L). The mean change in Edinburgh Hypoglycemia Score during clamp was attenuated from 10.7 (6.4) before surgery to 5.2 (4.9) after surgery. There were also marked postsurgery reductions in levels of glucagon, cortisol, and catecholamine and the sympathetic nerve responses to hypoglycemia. In addition, growth hormone displayed a delayed response but to a higher peak level. Levels of glucagon-like peptide 1 and gastric inhibitory polypeptide rose during hypoglycemia but rose less postsurgery compared with presurgery. Thus, GBP surgery causes a resetting of glucose homeostasis, which reduces symptoms and neurohormonal responses to hypoglycemia. Further studies should address the underlying mechanisms as well as their impact on the overall metabolic effects of GBP surgery.
Department of Medical Sciences, Uppsala University, Uppsala, Sweden niclas.abrahamsson@medsci.uu.se.
Niclas
N
Abrahamsson
Department of Medical Sciences, Uppsala University, Uppsala, Sweden Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden.
Joey Lau
JL
Börjesson
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Magnus
M
Sundbom
Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden.
Urban
U
Wiklund
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
F Anders
FA
Karlsson
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Jan W
JW
Eriksson
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002395:Catecholamines / Q000097:blood; D005260:Female; D015390:Gastric Bypass; D005749:Gastric Inhibitory Polypeptide / Q000097:blood; D005934:Glucagon / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D015309:Glucose Clamp Technique; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007003:Hypoglycemia / Q000097:blood* / Q000601:surgery*; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood* / Q000601:surgery*
D001786:Blood Glucose; D002395:Catecholamines; D007328:Insulin; D005749:Gastric Inhibitory Polypeptide; D052216:Glucagon-Like Peptide 1; D005934:Glucagon; D006854:Hydrocortisone