On the Impact of Bariatric Surgery on Glucose Homeostasis

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Abrahamsson, Niclas,1976-Uppsala universitet,Institutionen för medicinska vetenskaper,Endokrin och Diabetes, prof Jan Eriksson (författare)

On the Impact of Bariatric Surgery on Glucose Homeostasis

BokEngelska2016

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Uppsala :Acta Universitatis Upsaliensis,2016
73 s.
electronicrdacarrier

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LIBRIS-ID:oai:DiVA.org:uu-276381
ISBN:9789155494803
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-276381URI

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Språk:engelska
Sammanfattning på:engelska

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Ämneskategori:dok swepub-publicationtype

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Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine,1651-6206 ;1181

Anmärkningar

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.

Ämnesord och genrebeteckningar

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

Biuppslag (personer, institutioner, konferenser, titlar ...)

Eden Engström, Britt,DocentUppsala universitet,Institutionen för medicinska vetenskaper (preses)
Eriksson, Jan,ProfessorUppsala universitet,Institutionen för medicinska vetenskaper (preses)
Sundbom, Magnus (preses)
Docherty, Neil Gerard,College LecturerUniversity College Dublin, Dublin, Ireland (opponent)
Uppsala universitetInstitutionen för medicinska vetenskaper (creator_code:org_t)

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