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Islet function, insulin clearance affect patients after gastric bypass
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Excessive post-meal insulin response in patients who experience hypoglycemia after gastric bypass surgery can be traced to altered islet cell function and reduced insulin clearance, researchers found.
In a study conducted at the University of Cincinnati, 65 participants who underwent gastric bypass at least 2 years before enrollment were stratified based on post-meal symptoms of low blood glucose and studied during meal tolerance tests. An additional 11 people with the same BMI without surgery were also tested.
Marzieh Salehi
A team of researchers, led by Marzieh Salehi, MD, conducted a cross-sectional analysis of insulin secretion rate and islet and gastrointestinal hormone responses to liquid meal ingestion. Participants maintained their usual carbohydrate ingestion and engaged in no physical activities for 3 days, then fasted overnight. Baseline blood samples were taken, then each consumed a 237-mL liquid mixed meal (350 kcal; 57% carbohydrate, 15% protein and 28% fat). Blood samples were taken again from 0 to 180 minutes, and glucose concentration was determined using an automated analyzer.
Glucose and insulin responses to the liquid meal shifted up and to the left in patients who had gastric bypass, researchers found, with the largest early insulin response in patients with a history of hypoglycemia. Lower postprandial insulin clearance rates and higher insulin secretion rates during the glucose decline after the test meal were seen in patients with hypoglycemia who underwent gastric bypass. “We have shown that meal ingestion after gastric bypass surgery causes an earlier and larger peak of insulin secretion, and this effect is exaggerated in those with hypoglycemic symptoms following meals,” Salehi said in a press release.
Disclosures: The researchers report no relevant financial disclosures.
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