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Curiously, some bariatric RYGB patients experience up to a 10-fold increase in post-meal active GLP-1 plasmatic levels (from fasting 5 pM to post-prandial 3065 pM) (146), and have a 2- to 3-fold higher glucose-stimulated Insulin secretion (147), which in some diabetic patients results in GLP-1-mediated hyperinsulinemic hypoglycaemia that requires GLP-1 antagonism or surgical reversal of the intestinal anatomy (148)

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When a beta-lactam is attached to a protein, the R1-side chain sticks out

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