Continuous Glucose Monitoring After Gastric Bypass to Evaluate the Glucose Variability After a Low-Carbohydrate Diet and to Determine Hypoglycemia

2016 ◽  
Vol 26 (9) ◽  
pp. 2111-2118 ◽  
Author(s):  
Joan Bach Nielsen ◽  
Caroline Bruun Abild ◽  
Ane Mathilde Pedersen ◽  
Steen Bønløkke Pedersen ◽  
Bjørn Richelsen
Keyword(s):  
Gastric Bypass ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Glucose Variability ◽  
Carbohydrate Diet ◽  
Low Carbohydrate Diet ◽  
Low Carbohydrate

scholarly journals Relationship of Glucose Variability and Daily Lifestyle by Continuous Glucose Monitoring (CGM)

2020 ◽  
Vol 3 (3) ◽  
pp. 206-212
Author(s):  
Yamashita H ◽  
Kato Y ◽  
Bando H ◽  
Kanazawa S ◽  
Tanaka M ◽  
...  
Keyword(s):  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Glucose Variability ◽  
Future Research ◽  
Low Carbohydrate Diet ◽  
Freestyle Libre ◽  
Low Carbohydrate ◽  
Working Day ◽  
Multiple Daily Insulin Injections ◽  
Relationship Of

Authors and collaborators have continued diabetic practice and research on low carbohydrate diet (LCD), continuous glucose monitoring (CGM), and so on. The case is a 64-year-old male with type 2 diabetes mellitus (T2DM) treated with multiple daily insulin injections (MDI). When his HbA1c was 8.2% before, he changed to take tofu instead of rice and bread. HbA1c decreased to 7.1% and 4kg of weight reduction in 2 months. Tofu is a traditional Japanese food made from soybeans, which is a suitable LCD with Protein:Fat:Carbohydrate (PFC) ratio=40:45:15 in this case. His HbA1c is recently unstable, then glucose variability was investigated by CGM using FreeStyle Libre. The glucose pattern was different due to his lifestyle, including working day, off day, playing golf, respectively. The average glucose was 143-167 mg/dL and the estimated HbA1c was 7.1%, whereas HbA1c in outclinic was 8.1%, respectively. This report will hopefully become reference data for future research.

scholarly journals Normalized glucose variability by Low Carbohydrate Diet (LCD) in CGM study

2019 ◽  
Vol 2 (S1) ◽  
pp. 22-27
Author(s):  
Muneta T ◽  
Kawaguchi E ◽  
Hayashi M ◽  
Bando H ◽  
Ebe K
Keyword(s):  
Ketone Bodies ◽  
Glucose Monitoring ◽  
Glucose Variability ◽  
Carbohydrate Diet ◽  
Glucose Lowering ◽  
Low Carbohydrate Diet ◽  
Freestyle Libre ◽  
Low Carbohydrate ◽  
Glucose Lowering Effect

In diabetic practice, continuous glucose monitoring (CGM) has been more used for glucose variability. Authors have reported and developed the clinical study of Low Carbohydrate Diet (LCD) and Calorie Restriction (CR) through Japan LCD Promotion Association (JLCDPA). A diabetic case is presented with normalizing glucose variability by LCD meal checked by CGM. Case is 51 years female with type 2 diabetes mellitus (T2DM). At first visit, HbA1c was 10.0%, glucose was 288mg/dL, BMI 39.1, GOT 16IU/mL, HDL-C 33mg/dL, Triglyceride 152mg/dL. CR meal was provided on day-1 to day-5 and LCD meal with 12% carbohydrate on day-6 to day-13. Average glucose value from CGM was 292mg/dL, 235mg/dL, 160mg/dL, 140mg/dL, 124mg/dL in day 3,5,7,9,11 respectively. On day-13, total Ketone bodies (T-KB) 540μmol/L (-131), Acetoacetic acid (AcAc) 86μmol/L (-55) and 3-hydroxybutyric acid (3-OHBA) 454μmol/L (-85). Weight reduction was 5kg on day-14 and 11.2kg on day-70 with BMI 34.6. Thus, LCD showed a remarkable glucose-lowering effect in short term. FreeStyle Libre (Abbott, USA) seems to be a useful apparatus for monitoring the detailed fluctuation of blood glucose. These results would become fundamental and reference data and contribute to the LCD research development in the future.

Utility of Continuous Glucose Monitoring vs. Meal Study in Detecting Hypoglycemia After Gastric Bypass

2021 ◽  
Author(s):  
Henri Honka ◽  
Janet Chuang ◽  
David D’Alessio ◽  
Marzieh Salehi
Keyword(s):  
Gastric Bypass ◽  
Continuous Glucose Monitoring ◽  
Gastric Bypass Surgery ◽  
Late Complication ◽  
Glucose Monitoring ◽  
Glucose Variability ◽  
Postprandial Glucose ◽  
Healthy Weight ◽  
Free Living ◽  
Carbohydrate Ingestion

Abstract Context Gastric bypass (GB) increases postprandial glucose excursion, which in turn can predispose to the late complication of hypoglycemia. Diagnosis remains challenging and requires documentation of symptoms associated with low glucose, and relief of symptom when glucose is normalized (Whipple’s triad). Objective To compare the yield of mixed meal test (MMT) and continuous glucose monitoring system (CGMS) in detecting hypoglycemia after gastric bypass surgery (GB). Setting The study was conducted at General Clinical Research Unit, Cincinnati Children’s Hospital (Cincinnati, OH, United States). Methods Glucose profiles were evaluated in 15 patients with documented recurrent clinical hypoglycemia after GB, 8 matched asymptomatic GB subjects, and 9 healthy weight-matched non-operated controls using MMT in a control setting and CGMS under free-living conditions. Results Patients with prior GB had larger glucose variability during both MMT and CGMS when compared to non-surgical controls regardless of their hypoglycemic status. Sensitivity (71 vs. 47 %) and specificity (100 vs. 88 %) of MMT in detecting hypoglycemia was superior to CGMS. Conclusions Our findings indicate that a fixed carbohydrate ingestion during MMT is a more reliable test to diagnose GB-related hypoglycemia compared to CGMS during free-living state.

scholarly journals Urinary C-Peptide Excretion for Diabetic Treatment in Low Carbohydrate Diet (LCD)

2018 ◽  
pp. 13-18 ◽  
Author(s):  
Hiroshi Bando ◽  
Koji Ebe ◽  
Tetsuo Muneta ◽  
Masahiro Bando ◽  
Yoshikazu Yonei
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Glucose Variability ◽  
Carbohydrate Diet ◽  
C Peptide ◽  
Low Carbohydrate Diet ◽  
Low Carbohydrate ◽  
Diabetic Treatment ◽  
Average Glucose

Background: Arguments have continued about Low Carbohydrate Diet (LCD) and Calorie Restriction (CR). Authors have reported clinical research of LCD and Morbus (M) value. Subjects and Methods: Subjects enrolled are 84 patients with Type 2 diabetes mellitus (T2DM), 60.9 ± 10.9 years. The protocol were as follows: 1) CR diet on day 1, 2 with 60% carbohydrates, and LCD on day 3-14 with 12% carbohydrates, 2) Daily profile of blood glucose 7 times a day on day 2 (CR) and day 4 (LCD), 3) urinary C-Peptide radioimmunoassay (u-CPR) excretion, 4) M value calculation, 5) investigation of these data with correlation. Results: Subjects were classified into 4 groups according to M value, which were .4–21, 23–66, 29–192, 200–728, respectively. HbA1c value was 6.2, 8.0, 7.8, 9.2 %, respectively. Blood glucose in median from day 2 to day 4 were 123 to 107 mg/dL, 164 to 130 mg/dL, 193 to 156 mg/dL, 277 to 201 mg/dL, respectively. M value in median from day 2 to 4 was 6.3 to 9, 41 to 7, 108 to 16, 367 to 88, respectively. u-CPR was 88 to 58, 53 to 35, 65 to 52, 74 to 64, respectively. There were significant correlations among among glucose, M value and u-CPR. Discussion and Conclusion: Average glucose, M value and u-CPR decreased remarkably on day 4. As average glucose and M value were higher, decrease degree were larger. These results suggested that carbohydrate in meal would influence glucose variability in T2DM. Our data would become basic data for pathophysiological analysis of glucose variability research in the future.

scholarly journals Difference of Glucose variability between Low Carbohydrate Diet (LCD) and Calorie Restriction (CR)

2019 ◽  
Vol 2 (S1) ◽  
pp. 4-15 ◽  
Author(s):  
Hiroshi Bando ◽  
Koji Ebe ◽  
Tetsuo Muneta ◽  
Masahiro Bando ◽  
Yoshikazu Yonei
Keyword(s):  
Blood Glucose ◽  
Calorie Restriction ◽  
Mean Amplitude ◽  
Glucose Variability ◽  
Carbohydrate Diet ◽  
Low Carbohydrate Diet ◽  
Low Carbohydrate ◽  
Average Blood Glucose ◽  
Glucose Lowering Effect ◽  
The Difference

Background: There have been lots of discussion and controversy concerning the difference between Low Carbohydrate Diet (LCD) and Calorie Restriction (CR). The important points include glucose variability, glucose-lowering effect, weight reduction degree and influence on lipid metabolism. Subjects and Methods: Enrolled subjects were 47 patients with T2DM. Methods included the study for providing subjects CR meal with 60% carbohydrate on day 1-2 and LCD meal with 12% on day 3-14. Daily profile of blood glucose was studied seven times a day on day 2 and day 4. Further, biomarkers including HbA1c, average blood glucose, and M value were investigated and analyzed for mutual correlations. Results: Subjects were categorized into 4 groups according to the average glucose value, which were 124mg/dL, 160mg/dL, 206mg/dL, and 281mg/dL, respectively. Data in 4 groups were as follows: Number; 12,12,12,11, Male/Female; 6/6, 3/9, 6/6, 5/6, mean age; 51.3, 60.9, 65.3, 60.6 years old, HbA1c; 6.1%, 7.1%, 8.0%, 8.9%, fasting glucose on day 2; 109 mg/dL, 136 mg/dL, 178 mg/dL, 224mg/dL, respectively. Daily profiles of blood glucose in 4 groups on day 4 were remarkably decreased than those of day 2. The levels of M value indicating average blood glucose and mean amplitude of glycemic excursions (MAGE) on day 2 vs 4 were compared in 4 groups, which are 7.1 vs 10.5, 39.7 vs 5.0, 139 vs 15.7, 367 vs88, respectively. Correlations among HbA1c, M value and average blood glucose showed significant correlations (p<0.01). Discussion and Conclusion: Obtained results showed that the distribution of daily profile of blood glucose in 4 groups is separated. Further similar tendency was observed in HbA1c and M value.

scholarly journals Low carbohydrate diet and improved glycaemic control in a patient with type one diabetes

2018 ◽  
Vol 2018 ◽  
Author(s):  
Mirjam Eiswirth ◽  
Ewan Clark ◽  
Michael Diamond
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Glucose Variability ◽  
List Type ◽  
Carbohydrate Diet ◽  
Low Carbohydrate Diet ◽  
Low Carbohydrate ◽  
Type One Diabetes ◽  
Clinical Benefits

Summary We present the case of an adult female with type 1 diabetes, whose HbA1c was trending at 58 mmol/mol (7.5%) for the past 3 years. In August 2016, she reduced her total daily carbohydrate intake to 30–50 g and adjusted her other macronutrients to compensate for the calorific deficit. Her HbA1c fell to 34 mmol/mol (5.3%) by January 2017 and average daily blood glucose readings decreased significantly from 10.4 to 6.1 mmol/L. Moreover, she observed a marked reduction of average daily glucose variability. Notably, there were no significant episodes of hypo- or hyperglycaemia and her lipid profile remained static. Subjectively, she described an improvement in her quality of life and the dietary transition was extremely well tolerated. We discuss these findings in detail and the potential clinical benefits for patients with type 1 diabetes that can be gained by following a low carbohydrate diet. Learning points: A low carbohydrate diet was found to substantially reduce HbA1c values and blood glucose (BG) variability, as well as causing a significant reduction in average daily glucose values in a patient with T1DM. Although further research is warranted, low carbohydrate diets in patients with T1DM have the potential to positively impact long-term morbidity and mortality through reduction of BG variability and average daily BG values. The diet was well tolerated and not associated with any adverse effects within this study.

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