Hormone action likely culprit of hypoglycemia after gastric bypass surgery

March 12, 2014 by Angela Koenig, University of Cincinnati
A hemoglobin AIC test is used to monitor blood sugar control. It is one of many outcomes measures being reported through PQRI.

(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.

These findings, which are featured in the March 2014 edition of the journal Gastroenterology, are part of an ongoing effort by UC researchers to better understand glucose metabolism after weight-loss surgeries and the physiological factors leading to improvement of hyperglycemia in majority of patients with Type 2 diabetes as well as glucose abnormalities in the individuals who suffer from low sugar syndrome after .

"Over the years we have recognized that gastric bypass is very effective for treatment of obesity and and has an immediate and robust effect on glucose improvement in patients with Type 2 diabetes. However, there is a subgroup of patients where gastric bypass surgery creates a situation of hypoglycemia, associated with too much of insulin secretion after meal ingestion, several years after surgery," says Marzieh Salehi, MD, associate professor in the division of endocrinology, metabolism and diabetes, UC Health physician and lead investigator.

"It's a common story … we get calls from all over the country from people asking for help," she says, adding that symptoms of hyperinsulinemic hypoglycemia in bypass patients often overlap with "dumping" syndrome, a common aftereffect of bypass surgery, therefore, diagnosis of glucose abnormalities after surgery remains to be a challenge.

"Patients with hyperinsulinemic hypoglycemic have excessive insulin production in response to eating," she says, explaining that the symptoms of hypoglycemia can start out slowly with post-meal dizziness, sweating, fast heart beats, tingling and fatigue, which generally get better immediately by taking carbohydrates.

Over time, Salehi says, the condition progress and could cause symptoms consistent with cognitive impairment. Patients "just pass out with no warning," she says.

Funded by a grant from the National Institutes of Health, this study focused specifically on blocking the gut hormone Glucagon-like Peptide 1 (GLP-1), which is enhanced after gastric bypass surgery.

Twenty-four subjects were recruited for the study: nine with recurrent hypoglycemia after gastric bypass, seven with no symptoms of hypoglycemia after gastric bypass and eight healthy control subjects. All underwent a mixed meal tolerance test and with and without use of GLP-1 blocker.

The result, Salehi says, is that post-meal levels were corrected in all patients and this effect was mediated by lowering in affected subjects.

This study has implications for treatment of hyperinsulinemia after gastric bypass as well as better understanding of mechanisms by which this surgery alters in general. At this point there is no specific therapeutic option available for with this condition beyond dietary modification.

According to Salehi, gastric bypass is the most commonly performed bariatric surgery (60 to 80 percent) in the U.S. It is estimated that more than 700,000 persons in the U.S. have undergone over the last decade based on an estimated 110,000 bariatric procedures per year since 2003.

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

Related Stories

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 ...

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 ...

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 ...

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 ...

Bariatric surgical procedures have similar therapeutic benefits in obese adults

November 26, 2012
Obesity is associated with insulin resistance and type 2 diabetes, both of which can be significantly improved by weight loss. Gastric bypass and adjustable gastric banding are two bariatric surgery techniques that are frequently ...

Recommended for you

Genetic discovery may help better identify children at risk for type 1 diabetes

January 17, 2018
Six novel chromosomal regions identified by scientists leading a large, prospective study of children at risk for type 1 diabetes will enable the discovery of more genes that cause the disease and more targets for treating ...

Women who have gestational diabetes in pregnancy are at higher risk of future health issues

January 16, 2018
Women who have gestational diabetes mellitus (GDM) during pregnancy have a higher than usual risk of developing type 2 diabetes, hypertension, and ischemic heart disease in the future, according to new research led by the ...

Diabetes gene found that causes low and high blood sugar levels in the same family

January 15, 2018
A study of families with rare blood sugar conditions has revealed a new gene thought to be critical in the regulation of insulin, the key hormone in diabetes.

Discovery could lead to new therapies for diabetics

January 12, 2018
New research by MDI Biological Laboratory scientist Sandra Rieger, Ph.D., and her team has demonstrated that an enzyme she had previously identified as playing a role in peripheral neuropathy induced by cancer chemotherapy ...

Enzyme shown to regulate inflammation and metabolism in fat tissue

January 11, 2018
The human body has two primary kinds of fat—white fat, which stores excess calories and is associated with obesity, and brown fat, which burns calories in order to produce heat and has garnered interest as a potential means ...

Big strides made in diabetes care

January 5, 2018
(HealthDay)—This past year was a busy, productive one for diabetes research and care.

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.