Clinical Studies on Abnormal Carbohydrate Metabolism in Patients Following Gastrectomy

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  • TAKEDA M.
    Hyogo Prefectural Kakogawa Hospital, Kakogawa City, Hyogo, Japan
  • MIKI S.
    Hyogo Prefectural Kakogawa Hospital, Kakogawa City, Hyogo, Japan
  • TANAKA I.
    Hyogo Prefectural Kakogawa Hospital, Kakogawa City, Hyogo, Japan
  • FUKUDA T.
    Hyogo Prefectural Kakogawa Hospital, Kakogawa City, Hyogo, Japan
  • SHIMA I.
    Hyogo Prefectural Kakogawa Hospital, Kakogawa City, Hyogo, Japan
  • MORI Y.
    Hyogo Prefectural Kakogawa Hospital, Kakogawa City, Hyogo, Japan
  • NOMURA K.
    Hyogo Prefectural Kakogawa Hospital, Kakogawa City, Hyogo, Japan
  • HASEGAWA M.
    Hyogo Prefectural Kakogawa Hospital, Kakogawa City, Hyogo, Japan
  • INAGAKI O.
    Hyogo Prefectural Kakogawa Hospital, Kakogawa City, Hyogo, Japan

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Other Title
  • 胃切除後糖尿病における異常糖質代謝に関する臨床的観察
  • イ セツジョ ゴ トウニョウビョウ ニ オケル イジョウ トウシツ タイシャ ニ カンスル リンショウテキ カンサツ

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Abstract

It has been reported previously that the abnormal carbohydrate metabolism characterized by oxyhyperglycemia and final hypoglicemia in oral glucose tolerance test was often seen in patients following gastrectomy.<BR>In order to elucidate whether the characteristic abnormality abnormality of carbohydrate metabolism was based on the pancreatic or extrapancreatic origin, it eas been particularly attempted to distinguish those two origins by observation of Staub-Effect and hypoglycemia in final blood sugar level in twice oral administration of 50 gm glucose.<BR>The degree of positive or negative Staub-Effect was determined by comparing the percentage of the blood sugar levels between the first and later half of peak blood sugar value in twice oral glucose administration, and the final blood sugar level was compared with fasting blood sugar level to demonstrate the final hypoglycemia in GTT.<BR>The results are as follows.<BR>(1) The Staub-Effect was markedly positive in 48 patients out of the 52 cases. Out of these 48 Staub-Effect positive patients, extremely positive were seen in 13 patients, severely in 17 patients, moderately in 9 patients and mildly in 9 patients. Staub-Effect was negative in only 3 cases and one was a borderline case.<BR>(2) The final hypoglycemia following twice oral glucose administration was seen in all cases excluding the 3 cases. We divided the degree of final hypoglycemia into 4 groups. Among the 48 patients who showed the final hypoglycemia, its degree was mild (less than 10%) in 13 patients, moderate (over 10 to 20%) in 7 patients, severe (over 20 to 30%) in 15 patients and extreme (over 30%) in 14 patients.<BR>(3) The blood sugar curve following the oral glucose administration reached its peak earier than the diabetics in most cases. In total, 30 minutes after the first administration of glucose, the hyperglycemic peak appeared in 88% of these cases.<BR>(4) The total amount of excreted urinary sugar following the twice oral admistration of 50 gm glucose was less than 2.0 gm, and only 3 cases were more than 2.0 gm.<BR>(5) In nearly all cases, the higher excretion of urinary sugar was found after the first half of glucose administration, which seemed to be parallel to the blood sugar curve.<BR>(6) The peak of blood sugar levels following the twice oral glucose tolerance test showed ower 100 to 200 mg/dl in the majority of the cases.<BR>(7) Non-responsiveness in treatment with Sulfonyl-Urea and usual dietary restriction was seen in most cases. Diabetic neuropathia appeared in several cases, however no retinopathia was found.<BR>From the results described above, it may be suggested that the characteristic abnormality of carbohydrate metabolism in patient following gastrectomy is based on the extrapancreatic origin.

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