Can Postprandial Reactive Hypoglycaemia be Reduced in Patients After Roux-en-Y Gastric Bypass With a Low Carbohydrate Diet?

Amirsalar Samkani

Status: Completed

Conditions: Bariatric Surgery (Gastric Bypass)

Treatments: Other: Low carbohydrate meals; Other: Standard carbohydrate meals

Study type: Interventional

Funder types: Other

Identifiers

NCT02665715

DK-REAKTIV-15

Details and patient eligibility

About

Roux-en-Y gastric bypass (RYGB) accelerates nutrient delivery to the small intestine causing higher peak blood glucose concentration early after meal intake. In the late postprandial period (1 1⁄2-2 h) nadir blood glucose level is lower compared with before operation. In some patients, overt postprandial hypoglycaemia develops, and is typically reported as a complication 1-5 years postoperatively, when maximal weight loss has been obtained. The pathophysiology of postprandial hypoglycaemia involves inappropriate hyper-secretion of insulin associated with exaggerated secretion of the gut hormone glucagon-like peptide-1 (GLP-1) leading to a mismatch between glucose absorption rate, insulin secretion and whole body glucose disposal. We hypothesize that lowering carbohydrate content of meals reduces postprandial glucose excursions whereby GLP-1 and insulin secretion is reduced and reactive hypoglycemia prevented.

Enrollment: 10 patients

Sex: All

Ages: 25 to 70 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• RYGB operated patients more than 12 month after operation
• Stable in weight for at least 3 months (+/- 3 kg)
• Plasma glucose below 3.4 mmol/L after screening with test meal (Fresubin drink) or with continuous glucose monitoring

Exclusion criteria

• Fasting plasma glucose concentration > 7mmol/L
• Critical illness
• Hgb < 6.5 mM
• Pregnancy or breastfeeding

Trial design

Primary purpose: Basic Science

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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10 participants in 2 patient groups

Low carbohydrate/Standard carbohydrate

Experimental group

Description:

10 Roux-en-Y gastric bypass operated subjects are tested two days with mixed-meal tests. Each studytest day consist of both breakfast and lunch.

Treatment:

Other: Standard carbohydrate meals

Other: Low carbohydrate meals

Standard carbohydrate/Low carbohydrate

Experimental group

Description:

10 Roux-en-Y gastric bypass operated subjects are tested two days with mixed-meal tests. Each studytest day consist of both breakfast and lunch.

Treatment:

Other: Standard carbohydrate meals

Other: Low carbohydrate meals