Reductions in glucagon, cortisol, catecholamine, and sympathetic nerve responses to hypoglycemia

Gastric bypass (GBP) surgery is associated with reduced symptoms and neurohormonal responses to hypoglycemia, according to a study published online June 16 in Diabetes.

From HealthDay

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Noting that GBP patients have lowered glucose levels and frequent asymptomatic hypoglycemic episodes, Niclas Abrahamsson, M.D., Ph.D., from Uppsala University in Sweden, and colleagues examined symptoms and hormonal and autonomic nerve responses in patients exposed to hypoglycemia before and after GBP. Twelve obese patients without diabetes underwent hyperinsulinemic hypoglycemic clamp before and after GBP surgery.

The researchers found that after surgery the Edinburgh Hypoglycemia symptom delta scores during clamp were attenuated from 10.7 to 5.2. Marked reductions in glucagon, cortisol, catecholamine, and sympathetic nerve responses to hypoglycemia were seen after surgery. A delayed response was seen in growth hormones, but to a higher peak level. During hypoglycemia, glucagon-like peptide-1 and gastric inhibitory peptide increased, but to a lesser extent after surgery.

"GBP surgery causes a resetting of glucose homeostasis, which reduces symptoms and neurohormonal responses to hypoglycemia," the authors write. "Further studies should address the underlying mechanisms as well as their impact on the overall metabolic effects of GBP surgery."

ABSTRACT

Gastric bypass reduces symptoms and hormonal responses in hypoglycemia

Niclas Abrahamsson, Joey Lau Börjesson, Magnus Sundbom, Urban Wiklund, F Anders Karlsson, Jan WEriksson

Diabetes 2016 Jun; db160341. http://dx.doi.org/10.2337/db16-0341
Gastric bypass (GBP) surgery, one of the most common bariatric procedures, induces weight loss and metabolic effects. The mechanisms are not fully understood, 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 GBP to hypoglycemia and examined symptoms, hormonal and autonomic nerve responses. 12 obese, non-diabetes patients, 8 women, age 43.1 years (SD 10.8), BMI 40.6 kg/m2 (3.1), were examined before and 23 (19-25) weeks after GBP surgery with hyperinsulinemic hypoglycemic clamp (stepwise to plasma glucose 2.7 mmol/L).The Edinburgh Hypoglycemia symptom delta scores during clamp were attenuated from 10.7 (6.4) before to 5.2 (4.9) after surgery. There were also marked post-surgery reductions in glucagon, cortisol, catecholamine and sympathetic nerve responses to hypoglycemia. In addition, growth hormone displayed a delayed response but to a higher peak level. GLP-1 and GIP rose during hypoglycemia, but less post- vs. pre-surgery. 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.
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