Cause for exaggerated insulin response in subset of bariatric surgery patients identified

March 27, 2014

University of Cincinnati (UC) researchers have discovered that altered islet cell function and reduced insulin clearance contribute to excessive post-meal insulin response in patients experiencing low blood sugar symptoms (hypoglycemia) following gastric bypass surgery.

These findings, led by Marzieh Salehi, MD, associate professor in the UC division of endocrinology, metabolism and diabetes, are featured online this month in The Journal of Clinical Endocrinology & Metabolism, and are part of an ongoing effort by UC researchers to better understand the effect of gastric on glucose metabolism and islet function.

Gastric bypass surgery has been shown to be one of the most effective treatments for obesity, and often improves Type 2 diabetes immediately after surgery and long before any weight loss has occurred—a phenomenon that's been attributed to earlier and larger response to meal ingestion.

"For the majority of patients with , gastric bypass surgery leads to improved glucose control, but a subset of patients develop post-meal hypoglycemia—associated with too much of an insulin response—several years after surgery," says Salehi, also a physician with UC Health.

For this study Salehi and colleagues enrolled 65 subjects who had gastric bypass surgery at least two years prior to enrollment. Participants were stratified based on post-meal symptoms of low blood sugar and studied during meal tolerance tests.

"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," says Salehi, who adds that the effect is particularly exaggerated in those with neuroglycopenic symptoms (cognitive abnormalities, loss of consciousness, and seizure) rather than autonomic symptoms (fast heart beats, sweating, tingling, fatigue).

According to Salehi and team, this is the largest group of patients with post-meal symptoms of to be reported to date; and among this group, abnormalities in insulin clearance as well as excessive insulin secretion during glucose drops (hyperinsulinemia) were identified.

"These abnormalities contributed to elevated insulin response and lower glucose levels in these individuals," says Salehi.

Moreover, Salehi says, findings from this study suggest that in addition to excessive insulin secretion, glucagon response to hypoglycemia is abnormal. Glucagon is another important hormone in glucose regulation. It is secreted from specific cells in the pancreas in response to low glucose.

This study, the authors says, offers a better understanding of mechanisms by which alters glucose in general, and more specifically in those individuals suffering from hyperinsulinemic syndrome.

At this point, Salehi adds, there is no specific therapeutic option available for patients with this condition beyond dietary modification; however, we expect that the future studies based on current findings will inform the development of medical and dietary interventions for treatment of this condition.

Explore further: Hormone action likely culprit of hypoglycemia after gastric bypass surgery

Related Stories

Hormone action likely culprit of hypoglycemia after gastric bypass surgery

March 12, 2014
(Medical Xpress)—Researchers at the University of Cincinnati (UC) have discovered that blocking the action of one of the gut hormones can correct post-meal hypoglycemia (low blood sugar) in gastric bypass patients.

Research reveals hormone action that could lead to treatments for type 2 diabetes

September 30, 2011
(Medical Xpress) -- Researchers at the University of Cincinnati have discovered that the immediate improvement in blood sugar (blood glucose) for those with type 2 diabetes who undergo gastric bypass surgery is related to ...

Gastric bypass surgery alters hormones to relieve diabetes symptoms

April 30, 2013
–Gastric bypass surgery alters the hormones and amino acids produced during digestion, hinting at the mechanisms through which the surgery eliminates symptoms of type 2 diabetes, according to a recent study accepted for ...

Gut hormone test predicts individual efficacy of gastric bypass

November 8, 2013
The sensitivity of the GLP-1 hormone, which is secreted by the gastrointestinal tract, can predict the metabolic efficacy of a gastric bypass. The use of a GLP1 challenge could thus function as a novel predictive biomarker ...

Adjustable gastric banding more effective when combined with gastrointestinal hormone GLP-1

June 20, 2013
Pharmacological activation of the receptor for glucagon-like peptide 1 (GLP-1) in conjunction with adjustable gastric banding (AGB) surgery may improve weight loss outcomes achieved with this procedure when compared to performing ...

Recommended for you

Scientists discover a new way to treat type 2 diabetes

July 21, 2017
Medication currently being used to treat obesity is also proving to have significant health benefits for patients with type 2 diabetes. A new study published today in Molecular Metabolism explains how this therapeutic benefit ...

Alzheimer's drug cuts hallmark inflammation related to metabolic syndrome by 25 percent

July 20, 2017
An existing Alzheimer's medication slashes inflammation and insulin resistance in patients with metabolic syndrome, a potential therapeutic intervention for a highly dangerous condition affecting 30 percent of adults in the ...

Diabetes or its precursor affects 100 million Americans

July 19, 2017
Almost one-third of the US population—100 million people—either has diabetes or its precursor condition, known as pre-diabetes, said a government report Tuesday.

One virus may protect against type 1 diabetes, others may increase risk

July 11, 2017
Doctors can't predict who will develop type 1 diabetes, a chronic autoimmune disease in which the immune system destroys the cells needed to control blood-sugar levels, requiring daily insulin injections and continual monitoring.

Diabetes complications are a risk factor for repeat hospitalizations, study shows

July 7, 2017
For patients with diabetes, one reason for hospitalization and unplanned hospital readmission is severe dysglycemia (uncontrolled hyperglycemia - high blood sugar, or hypoglycemia - low blood sugar), says new research published ...

Researchers identify promising target to protect bone in patients with diabetes

July 7, 2017
Utilizing metabolomics research techniques, NYU Dentistry researchers investigated the underlying biochemical activity and signaling within the bone marrow of hyperglycemic mice with hopes of reducing fracture risks of diabetics

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.