Advertisement

Obesity Surgery

, Volume 20, Issue 8, pp 1110–1116 | Cite as

Glucose-Stimulated Insulin Secretion in Gastric Bypass Patients with Hypoglycemic Syndrome: No Evidence for Inappropriate Pancreatic β-cell Function

  • Sun H. Kim
  • Fahim Abbasi
  • Cindy Lamendola
  • Gerald M. Reaven
  • Tracey McLaughlin
Clinical Research

Abstract

Background

Roux-en-Y gastric bypass surgery (RYGB) has been associated with a hypoglycemic syndrome characterized by postprandial hypoglycemia and hyperinsulinemia. The syndrome is believed to occur due to insulin hypersecretion from either pancreatic β-cell hyperplasia or hyperfunction.

Methods

Eight RYGB patients with hypoglycemic syndrome had insulin secretion rates determined during a 240-min graded intravenous glucose infusion. They were compared to 34 nondiabetic, nonsurgical individuals who were divided based on their insulin sensitivity status as measured by the insulin suppression test: insulin-sensitive (n = 8), insulin intermediate (n = 7), and insulin-resistant (n = 19).

Results

RYGB patients had insulin concentrations and HOMA-IR similar to the insulin-sensitive reference group. In addition, integrated insulin secretion rates were comparable to the insulin-sensitive group and significantly lower than the insulin intermediate (p ≤ 0.046) and insulin-resistant groups (p ≤ 0.001). Pancreatic β-cell sensitivity to glucose (slope relating glucose and ISR) was lowest in the RYGB group (p ≤ 0.04).

Conclusions

Patients with hypoglycemic syndrome post-RYGB do not have generalized hypersecretion of insulin and appear to have appropriate insulin secretion rate in response to intravenous glucose.

Keywords

Gastric bypass Hypoglycemia Hyperinsulinemia Insulin secretion 

Notes

Acknowledgements

Funding support was provided by NIH Research Grants RR-00070 and K23 MH079114 (SHK).

Conflict of Interest

The authors have no conflicts of interest to disclose.

References

  1. 1.
    Service GJ, Thompson GB, Service FJ, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med. 2005;353:249–54.CrossRefPubMedGoogle Scholar
  2. 2.
    Patti ME, McMahon G, Mun EC, et al. Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia. Diabetologia. 2005;48:2236–40.CrossRefPubMedGoogle Scholar
  3. 3.
    Clancy TE, Moore Jr FD, Zinner MJ. Post-gastric bypass hyperinsulinism with nesidioblastosis: subtotal or total pancreatectomy may be needed to prevent recurrent hypoglycemia. J Gastrointest Surg. 2006;10:1116–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Bantle JP, Ikramuddin S, Kellogg TA, et al. Hyperinsulinemic hypoglycemia developing late after gastric bypass. Obes Surg. 2007;17:592–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Meier JJ, Butler AE, Galasso R, et al. Hyperinsulinemic hypoglycemia after gastric bypass surgery is not accompanied by islet hyperplasia or increased beta-cell turnover. Diabetes Care. 2006;29:1554–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Goldfine AB, Mun EC, Devine E, et al. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. J Clin Endocrinol Metab. 2007;92:4678–85.CrossRefPubMedGoogle Scholar
  7. 7.
    Kim SH, Liu TC, Abbasi F et al. Plasma glucose and insulin regulation is abnormal following gastric bypass surgery with or without neuroglycopenia. Obes Surg. 2009.Google Scholar
  8. 8.
    Kim SH, Abbasi F, Chu JW, et al. Rosiglitazone reduces glucose-stimulated insulin secretion rate and increases insulin clearance in nondiabetic, insulin-resistant individuals. Diabetes. 2005;54:2447–52.CrossRefPubMedGoogle Scholar
  9. 9.
    Jones CN, Pei D, Staris P, et al. Alterations in the glucose-stimulated insulin secretory dose-response curve and in insulin clearance in nondiabetic insulin-resistant individuals. J Clin Endocrinol Metab. 1997;82:1834–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Jones CN, Abbasi F, Carantoni M, et al. Roles of insulin resistance and obesity in regulation of plasma insulin concentrations. Am J Physiol Endocrinol Metab. 2000;278:E501–8.PubMedGoogle Scholar
  11. 11.
    Van Cauter E, Mestrez F, Sturis J, et al. Estimation of insulin secretion rates from C-peptide levels. Comparison of individual and standard kinetic parameters for C-peptide clearance. Diabetes. 1992;41:368–77.CrossRefPubMedGoogle Scholar
  12. 12.
    Pei D, Jones CN, Bhargava R, et al. Evaluation of octreotide to assess insulin-mediated glucose disposal by the insulin suppression test. Diabetologia. 1994;37:843–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Shen SW, Reaven GM, Farquhar JW. Comparison of impedance to insulin-mediated glucose uptake in normal subjects and in subjects with latent diabetes. J Clin Invest. 1970;49:2151–60.CrossRefPubMedGoogle Scholar
  14. 14.
    Greenfield MS, Doberne L, Kraemer F, et al. Assessment of insulin resistance with the insulin suppression test and the euglycemic clamp. Diabetes. 1981;30:387–92.CrossRefPubMedGoogle Scholar
  15. 15.
    Yeni-Komshian H, Carantoni M, Abbasi F, et al. Relationship between several surrogate estimates of insulin resistance and quantification of insulin-mediated glucose disposal in 490 healthy nondiabetic volunteers. Diabetes Care. 2000;23:171–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Facchini FS, Hua N, Abbasi F, et al. Insulin resistance as a predictor of age-related diseases. J Clin Endocrinol Metab. 2001;86:3574–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Lin E, Davis SS, Srinivasan J, et al. Dual mechanism for type-2 diabetes resolution after Roux-en-Y gastric bypass. Am Surg. 2009;75:498–502. discussion 502-3.PubMedGoogle Scholar
  19. 19.
    Muscelli E, Mingrone G, Camastra S, et al. Differential effect of weight loss on insulin resistance in surgically treated obese patients. Am J Med. 2005;118:51–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Vidal J, Nicolau J, Romero F, et al. Long-term effects of Roux-en-Y gastric bypass surgery on plasma glucagon-like peptide-1 and islet function in morbidly obese subjects. J Clin Endocrinol Metab. 2009;94:884–91.CrossRefPubMedGoogle Scholar
  21. 21.
    Nauck MA. Unraveling the science of incretin biology. Am J Med. 2009;122:S3–10.CrossRefPubMedGoogle Scholar
  22. 22.
    Laferrere B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab. 2008;93:2479–85.CrossRefPubMedGoogle Scholar
  23. 23.
    Kjems LL, Holst JJ, Volund A, et al. The influence of GLP-1 on glucose-stimulated insulin secretion: effects on beta-cell sensitivity in type 2 and nondiabetic subjects. Diabetes. 2003;52:380–6.CrossRefPubMedGoogle Scholar
  24. 24.
    McLaughlin T, Peck M, Holst J, et al. Reversible hyperinsulinemic hypoglycemia after gastric bypass: a consequence of altered nutrient delivery. J Clin Endocrinol Metab. 2010;95:41851–5.CrossRefGoogle Scholar
  25. 25.
    Hales CN, Randle PJ. Effects of low-carbohydrate diet and diabetes mellitus on plasma concentrations of glucose, non-esterified fatty acid, and insulin during oral glucose-tolerance tests. Lancet. 1963;1:790–4.CrossRefPubMedGoogle Scholar
  26. 26.
    Peterson DT, Reaven GM. Evidence that glucose load is an important determinant of plasma insulin response in normal subjects. Diabetes. 1971;20:729–33.PubMedGoogle Scholar
  27. 27.
    Crapo PA, Reaven G, Olefsky J. Olefsky J Postprandial plasma-glucose and -insulin responses to different complex carbohydrates. Diabetes. 1977;26:1178–83.CrossRefPubMedGoogle Scholar
  28. 28.
    Golay A, Coulston AM, et al. Comparison of metabolic effects of white beans processed into two different physical forms. Diabetes Care. 1986;9:260–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Kellogg TA, Bantle JP, Leslie DB, et al. Postgastric bypass hyperinsulinemic hypoglycemia syndrome: characterization and response to a modified diet. Surg Obes Relat Dis. 2008;4:492–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Sun H. Kim
    • 1
    • 2
  • Fahim Abbasi
    • 1
  • Cindy Lamendola
    • 1
  • Gerald M. Reaven
    • 1
  • Tracey McLaughlin
    • 1
  1. 1.Department of MedicineStanford University School of MedicineStanfordUSA
  2. 2.Stanford University Medical CenterStanfordUSA

Personalised recommendations