1. Continuous glucose monitoring reveals glycemic variability and hypoglycemia after vertical sleeve gastrectomy in rats
- Author
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Ki-Suk Kim, Diana M. Farris, Daniel E. Michele, Alfor G. Lewis, Youngsoo Kim, Matthew J. Sorensen, Robert T. Kennedy, Randy J. Seeley, Nadejda Bozadjieva, Steven E. Whitesall, Darleen A. Sandoval, and Simon S. Evers
- Subjects
Blood Glucose ,Male ,0301 basic medicine ,endocrine system diseases ,OGTT, oral glucose tolerance test ,medicine.medical_treatment ,Exendin 9-39 ,Ex9, exendin 9-39 ,DPP-4, dipeptidyl peptidase-4 ,Gastroenterology ,0302 clinical medicine ,Medicine ,Glycemic variability ,Continuous glucose monitoring ,GIP, gastric inhibitory polypeptide ,MAG, mean absolute glucose ,PBH, post–bariatric surgery hypoglycemia ,3. Good health ,Current medication ,Original Article ,Epi, epinephrine ,Postprandial Hypoglycemia ,lcsh:Internal medicine ,medicine.medical_specialty ,Sleeve gastrectomy ,Rat model ,030209 endocrinology & metabolism ,Hypoglycemia ,Glucagon-Like Peptide-1 Receptor ,03 medical and health sciences ,VSG, vertical sleeve gastrectomy ,Gastrectomy ,Internal medicine ,PYY, peptide YY ,2DG, 2-deoxyglucose ,Animals ,CGM, continuous glucose monitoring ,lcsh:RC31-1245 ,Molecular Biology ,Glycemic ,business.industry ,RYGB, Roux-en-Y gastric bypass ,nutritional and metabolic diseases ,Cell Biology ,Glucose Tolerance Test ,medicine.disease ,Post–bariatric surgery hypoglycemia ,Rats ,Blockade ,Disease Models, Animal ,030104 developmental biology ,Vertical sleeve gastrectomy ,business ,NE, norepinephrine ,GLP-1R, glucagon-like peptide-1 receptor - Abstract
Objective Post–bariatric surgery hypoglycemia (PBH) is defined as the presence of neuroglycopenic symptoms accompanied by postprandial hypoglycemia in bariatric surgery patients. Recent clinical studies using continuous glucose monitoring (CGM) technology revealed that PBH is more frequently observed in vertical sleeve gastrectomy (VSG) patients than previously recognized. PBH cannot be alleviated by current medication. Therefore, a model system to investigate the mechanism and treatment is required. Methods We used CGM in a rat model of VSG and monitored the occurrence of glycemic variability and hypoglycemia in various meal conditions for 4 weeks after surgery. Another cohort of VSG rats with CGM was used to investigate whether the blockade of glucagon-like peptide-1 receptor (GLP-1R) signaling alleviates these symptoms. A mouse VSG model was used to investigate whether the impaired glucose counterregulatory system causes postprandial hypoglycemia. Results Like in humans, rats have increased glycemic variability and hypoglycemia after VSG. Postprandial hypoglycemia was specifically detected after liquid versus solid meals. Further, the blockade of GLP-1R signaling raises the glucose nadir but does not affect glycemic variability. Conclusions Rat bariatric surgery duplicates many features of human post–bariatric surgery hypoglycemia including postprandial hypoglycemia and glycemic variability, while blockade of GLP-1R signaling prevents hypoglycemia but not the variability., Highlights • VSG causes glycemic variability during ad lib feeding condition. • Single liquid meal ingestion causes post-VSG hypoglycemia. • Blockade of GLP-1 receptor prevents post-VSG hypoglycemia.
- Published
- 2020
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