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KMID : 0352819960110010075
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Kosin Medical Journal
1996 Volume.11 No. 1 p.75 ~ p.84
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A Study on the Change of Glucose Metabolism after Gastrectomy
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Abstract
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Recently several cases of diabetes were found after undergoing gastrectomy. The loss of stomach profoundly affects glucose metabolism which may lead to the development of diabetes in a certain group of patients, particularly those with
diabetic risk factors such as family history, obesity, and other insulin resistance states. The purpose of this study is to investigate the changes in the plasma lipids and glucose metabolism and the risk factors of diabetes in patients
who are
planned to undergo gastrectomy so that it may help for the treatment and prevention of gastrectomy-related diabetes.
The non-diabetic patients who admitted to Kosin Medical Center for gastrectomy were prospectively studied since March 1, 1995. They were divided into 2 groups; those with family history of diabetes, overweight, obesity, or impaired
glucose tolerance on oral glucose tolerance test (OGTT) (GROUP I, N=5) AND THOSE WITHOUT (GROUP II, n=5). The ability to control blood glucose was evaluated by measuring blood glucose, insulin, C-peptide and glucagon during OGTT which was
performed before and 1 month after gastrectomy.
The out of 34 patients who entered the study were followed at 1 month after gastrectomy. Body weight decreased from 58.1±9.7 kg to 54.9±7.3 kg and values of other parameters of nutritional status also decreased. The levels of blood
glucose,
insulin, C-peptide, and glucagon generally increased at 0, 60, and 120 minutes during postoperative OGTT as compared to those levels during preoperative OGTT. The blood glucose level increased from 147.6±31.5 to 178.2±45.7 mg/dl at 60
min.
(p=0.07) and the insulin level increased from 38.1±27.0 uU/ml to 113.6±96.1 uU/ml at 60 min. (p=0.05). In preoperative OGTT the insulin level was higher at 60 min. and at 120 min. in group I than in group II (56.7±23.9 uU/ml vs.
19.4±11.6
uU/ml, p=0.03, respectively). Most patient took three meals a day and highly concentrated carbohydrate such as honey between meals. Impaired glucose tolerance developed postoperatively in one woman of overweight group but
none
of normal weight group. the development of impaired glucose tolerance in one of 3 overweighted women and abnormal glucose metabolism in general after gastrectomy suggests that postoperative risk of development of impaired glucose
tolerance be
substantial, particularly in pauents with diabetic risk factors such as obesity. To prevent the development of postoperative abnormal glucose metabolism adequated weight control before operation, preferably from young age, and
postoperative
measures to decrease excessive insulin secretion and hence insulin resistance, such as frequent small meals which consist of low carbohydrate and increased mono-and polyunsatuated fatty acid are suggested.
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KEYWORD
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