The overall goal of this project is to understand the mechanisms by which gastric bypass surgery improves glucose metabolism.
The central hypothesis guiding this project is that the reconfiguration of intestinal transit with the Roux-en-Y will increase the release of insulinotropic GI hormones, termed incretins that improve insulin secretion and glucose metabolism. The study is divided into three specific aims.
1. To determine the role of incretin hormones on insulin secretion in patients with gastric bypass surgery using intravenous-oral hyperglycemic clamp. 2. To compare incretin effect and glucose tolerance among patient who suffer from hypoglycemia after RYGB and asymptomatic surgical and non-surgical individuals. 3. To quantify the contribution of GLP-1 to incretin effect enhancement following surgery.
age 18-65
healthy control without diabetes or active organ disease
Individuals with bariatric surgery
recurrent hypoglycemia post gastric bypass
pregnancy
significant anemia
diabetes currently unless pre-op for bariatric surgery procedure
GI obstruction
Factorial
exendin-(9-39)
Drughyperglycemic clamp-meal tolerance test is designed to assess insulin secretion before and after meal ingestion
exendin -(9-39)
Drug2-day meal tolerance tests with labeled oral and IV glucose using exendin-(9-39) infusion are designed to evaluate the role of GLP-1 signaling on glucose tolerance and glucose kinetics.
The investigator measure glucose, islet and GI hormonal levels in response to meal ingestion as a composite measure and the percentage of contribution of GLP-1 contribution to postprandial insulin levels will also be calculated
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