Highlights
- •Minor counterregulatory responses to postprandial hypoglycemia after bariatric surgery
- •Aggravated hypoglycemia can increase counterregulatory hormone responses
- •Recurrent hypoglycemia may explain altered counterregulation after bariatric surgery
Abstract
Background
Postbariatric hypoglycemia (PBH) is a potentially serious complication after Roux-en-Y
gastric bypass (RYGB), and impaired counterregulatory hormone responses have been
suggested to contribute to the condition.
Objectives
We evaluated counterregulatory responses during postprandial hypoglycemia in individuals
with PBH who underwent RYGB.
Setting
University hospital.
Methods
Eleven women with documented PBH who had RYGB underwent a baseline liquid mixed meal
test (MMT) followed by 5 MMTs preceded by treatment with (1) acarbose 50 mg, (2) sitagliptin
100 mg, (3) verapamil 120 mg, (4) liraglutide 1.2 mg, and (5) pasireotide 300 μg.
Blood was collected at fixed time intervals. Plasma and serum were analyzed for glucose,
insulin, glucagon, epinephrine, norepinephrine, pancreatic polypeptide (PP), and cortisol.
Results
During the baseline MMT, participants had nadir blood glucose concentrations of 3.3
± .2 mmol/L. At the time of nadir glucose, there was a small but significant increase
in plasma glucagon. Plasma epinephrine concentrations were not increased at nadir
glucose but were significantly elevated by the end of the MMT. There were no changes
in norepinephrine, PP, and cortisol concentrations in response to hypoglycemia. After
treatment with sitagliptin, 8 individuals had glucose nadirs <3.2 mmol/L (versus 4
individuals at baseline), and significant increases in glucagon, PP, and cortisol
responses were observed.
Conclusions
In response to postprandial hypoglycemia, individuals with PBH who underwent RYGB
only had minor increases in counterregulatory hormones, while larger hormone responses
occurred when glucose levels were lowered during treatment with sitagliptin. The glycemic
threshold for counterregulatory activation could be altered in individuals with PBH,
possibly explained by recurrent hypoglycemia.
Keywords
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Article info
Publication history
Published online: September 03, 2020
Accepted:
August 30,
2020
Received:
June 18,
2020
Identification
Copyright
© 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
