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Does insulin sensitivity cause hypoglycaemia?

Study indicated that there are two distinct subgroups of hypoglycaemic patients

There appear to be distinct differences in whole body insulin sensitivity and insulin secretion among patients experiencing post-RYGB hypoglycaemia and this could explain the inconsistent clinical response to current medical and surgical treatments, according to research presented at ENDO2013, the annual meeting of the Endocrine Society, in San Francisco.

Investigators from Brody School of Medicine, ECU Brody School of Medicine and the East Carolina University, Greenville, NC, said that a previous study has reported a 2.7 fold increased risk for hypoglycaemia post-RYGB.

The complication usually occurs 1-2 hours after meals and “impacts the emotional and physical well-being of patients and current medical/surgical treatments are often ineffective due to a poor understanding of the mechanism(s) causing hypoglycaemia,” they noted.

As a result, the investigators performed minimal model testing on seven hypoglycaemic subjects to determine whether an increase in whole body insulin sensitivity and/or insulin secretion, compared to controls was contributing to the development of hypoglycaemia.

The results showed that insulin secretion, the mean acute insulin response to glucose (AIRg) in the post-RYGB hypoglycaemic cohort (age 44.3±9.3yr, BMI32.1±4.7,n=7) was 254±199mu/L·min, compared to 380±40mu/L·min in overweight, exercise trained cross-sectional controls (age 51.4+0.9yr, BMI28.6+0.4, n=43).

With regards to insulin sensitivity, the mean insulin sensitivity index (Si) from minimal model testing for the post-RYGB hypoglycaemic cohort was 7.5±5.03mU·l-1·min-1, compared to 4.1±0.5 mU·l-1·min-1 in the euglycaemic post-RYGB control (age 39.8±3.1yr, BMI27.1±0.9,n=11).

The researchers said that the preliminary data suggested that there are two distinct subgroups of hypoglycaemic patients:

  • High insulin sensitivity, low insulin secretion (Si 9.9±3.6 mU·l-1·min-1,AIRg 173±113mu/L·min, n=5); and
  • Low insulin sensitivity, high insulin secretion (Si 1.56±0.28 mU·l-1·min-1, AIRg 455±271mu/L·min, n=2).

“These findings suggest that assessing whole body insulin sensitivity and insulin secretion in post-RYGB hypoglycaemic patients, may better inform future treatment strategies for such patients,” they concluded.

This work was supported by a grant from the East Carolina Diabetes and Obesity Institute.

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