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- Abrahamsson, Niclas,1976-Uppsala universitet,Institutionen för medicinska vetenskaper,Endokrin och Diabetes, prof Jan Eriksson (author)
On the Impact of Bariatric Surgery on Glucose Homeostasis
- BookEnglish2016
Publisher, publication year, extent ...
- Uppsala :Acta Universitatis Upsaliensis,2016
- 73 s.
- electronicrdacarrier
Numbers
- LIBRIS-ID:oai:DiVA.org:uu-276381
- ISBN:9789155494803
- https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-276381URI
Supplementary language notes
- Language:English
- Summary in:English
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- SwePubSwePub
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Series
- Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine,1651-6206 ;1181
Notes
- Obesity has grown to epidemic proportions, and in lack of efficient life-style and medical treatments, the bariatric surgeries are performed in rising numbers. The most common surgery is the Gastric Bypass (GBP) surgery, with the Biliopancreatic diversion with duodenal switch (DS) as an option for the most extreme cases with a BMI>50 kg/m2.In paper I 20 GBP-patients were examined during the first post-operative year regarding the natriuretic peptide, NT-ProBNP, which is secreted from the cardiac ventricles. Levels of NT-ProBNP quickly increased during the first post-surgery week, and later established itself on a higher level than pre-surgery.In paper II we report of 5 patient-cases after GBP-surgery with severe problems with postprandial hypoglycaemia that were successfully treated with GLP-1-analogs. The effect of treatment could be observed both symptomatically and in some cases using continuous glucose measuring systems (CGMS).In paper III three groups of subjects; 15 post-GBP patients, 15 post-DS, and 15 obese controls were examined for three days using CGMS during everyday life. The post-GBP group had high glucose variability as measured by MAGE and CONGA, whereas the post-DS group had low variability. Both post-operative groups exhibited significant time in hypoglycaemia, about 40 and 80 minutes per day <3.3mmol/l and 20 and 40 minutes < 2.8mmol/l, respectively, longer time for DS-group. Remarkably, only about 20% of these hypoglycaemic episodes were accompanied with symptoms.In Paper IV the hypoglycaemia counter regulatory system was investigated; 12 patients were examined before and after GBP-surgery with a stepped hypoglycaemic hyperinsulinemic clamp. The results show a downregulation of symptoms, counter regulatory hormones (glucagon, cortisol, epinephrine, norepinephrine, growth hormone), incretin hormones (GLP-1 and GIP), and sympathetic nervous response.In conclusion patients post bariatric surgery exhibit a downregulated counter regulatory response to hypoglycaemia, accompanied by frequent asymptomatic hypoglycaemic episodes in everyday life. Patients suffering from severe hypoglycaemic episodes can often be treated successfully with GLP-1-analogues.
Subject headings and genre
- MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Endokrinologi och diabetes hsv//swe
- MEDICAL AND HEALTH SCIENCES Clinical Medicine Endocrinology and Diabetes hsv//eng
- Hypoglycaemia
- Gastric Bypass surgery
- Biliopancreatic diversion with duodenal switch (DS)
- NT-ProBNP
- Continuous glucose measuring system (CGMS)
- GLP-1-analog
- glucose variability
- MAGE
- CONGA
- counter regulation
- incretin
- Heart Rate Variability
- Endocrinology and Diabetology
- Endokrinologi och Diabetologi
Added entries (persons, corporate bodies, meetings, titles ...)
- Eden Engström, Britt,DocentUppsala universitet,Institutionen för medicinska vetenskaper (thesis advisor)
- Eriksson, Jan,ProfessorUppsala universitet,Institutionen för medicinska vetenskaper (thesis advisor)
- Sundbom, Magnus (thesis advisor)
- Docherty, Neil Gerard,College LecturerUniversity College Dublin, Dublin, Ireland (opponent)
- Uppsala universitetInstitutionen för medicinska vetenskaper (creator_code:org_t)
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