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Deficient Glucagon Response to Hypoglycemia During a Mixed Meal in Total Pancreatectomy/Islet Autotransplantation Recipients

Bogachus, Lindsey D ; Bellin, Melena D ; Vella, Adrian ; Robertson, R Paul

The journal of clinical endocrinology and metabolism, 2018-04, Vol.103 (4), p.1522-1529 [Periódico revisado por pares]

Washington, DC: Endocrine Society

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  • Título:
    Deficient Glucagon Response to Hypoglycemia During a Mixed Meal in Total Pancreatectomy/Islet Autotransplantation Recipients
  • Autor: Bogachus, Lindsey D ; Bellin, Melena D ; Vella, Adrian ; Robertson, R Paul
  • Assuntos: Adult ; Blood Glucose - metabolism ; Body mass ; Body mass index ; Clinical s ; Diabetes mellitus ; Female ; Glucagon ; Glucagon - blood ; Glucose ; Hormones ; Humans ; Hypoglycemia ; Hypoglycemia - blood ; Islets of Langerhans ; Islets of Langerhans Transplantation - methods ; Kinetics ; Male ; Meals ; Middle Aged ; Pain ; Pancreas ; Pancreatectomy ; Pancreatitis ; Pancreatitis, Chronic - blood ; Pancreatitis, Chronic - surgery ; Postprandial Period - physiology ; Transplantation, Autologous
  • É parte de: The journal of clinical endocrinology and metabolism, 2018-04, Vol.103 (4), p.1522-1529
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
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  • Descrição: Abstract Context Total pancreatectomy and intrahepatic islet autotransplantation (TP/IAT) is performed to alleviate severe abdominal pain, avoid narcotic use, maintain islet function, and avoid diabetes in patients with chronic pancreatitis. However, many TP/IAT recipients complain of postprandial hypoglycemia. Objective This study was designed to discover the mechanisms of this problem. Design Participants consumed a triple-isotope mixed meal. Setting This study was performed in a hospital research unit. Participants We studied 10 TP/IAT recipients and 10 age- and body mass index–matched control subjects. Seven of 10 recipients had a history of postprandial hypoglycemia. Interventions Participants were given a [1-13C]-labeled mixed meal and two tracer infusions ([6,6-2H2]- and [6-3H]-glucose). Main Outcome Measures Glucose kinetics and concentrations of regulatory hormones were determined. Results Immediately after the meal, peak glucose was elevated in recipients compared with control subjects [266 ± 20 mg/dL (14.8 ± 1.1 mmol/L) vs 185 ± 13 mg/dL (10.3 ± 0.7 mmol/L); P = 0.01]. However, mean Δ glucose for TP/IAT recipients between minutes 240 and 360 postprandially was significantly lower than for control subjects (P < 0.05); six of the seven recipients with a history of hypoglycemia experienced abnormally low postprandial Δ glucose. Δ Glucagon remained unchanged (minutes 240 to 360; P = 0.58) in TP/IAT recipients despite abnormal decreases in postprandial glucose. Radioisotopic studies revealed that meal appearance, glucose disappearance, and endogenous glucose production in TP/IAT recipients were not different from control subjects. Conclusion Initially high glucose levels followed by hypoglycemia with an absent glucagon response is a mechanistic sequence that contributes to postprandial hypoglycemia after TP/IAT. TP/IAT recipients consumed a triple-isotope mixed meal and experienced hypoglycemia during the latter half of a 6-hour study. The only abnormality they demonstrated was a deficient glucagon response.
  • Editor: Washington, DC: Endocrine Society
  • Idioma: Inglês
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