Total pancreatectomy increases the metabolic response to glucagon in humans Journal Article
| Authors: | Bajorunas, D. R.; Fortner, J. G.; Jaspan, J.; Sherwin, R. S. |
| Article Title: | Total pancreatectomy increases the metabolic response to glucagon in humans |
| Abstract: | To evaluate the impact of glucagon deficiency on the response to glucagon replacement, we infused physiological doses of glucagon (1.25 ng/kg-min) into 9 totally pancreatectomized (PX) diabetic patients (C-peptide, undetectable) 1) for 24 h during their usual diet and insulin regimen and/or 2) for 6 h in a fasted insulin-withdrawn state. During both glucagon infusions, plasma glucagon rose from 46 ± 2 (±SE) pg/ml (0- 10% 3500 niol wt glucagon) to 112 ± 9 pg/ml. In the 24-h study (n = 4), glucagon significantly increased mean 24-h glucose levels (272 ± 27 mg/dl; P < 0.05) and glycosuria (29±5 g/day; P < 0.01) compared to preinfusion (158 ± 14 mg/dl and 4 ± 4 gday, respectively) and postinfusion (200 ± 35 mg/dl and 3 ± 2 g/day) control periods. Blood ketones did not change. The 24-h glucagon infusion significantly lowered the fasting levels of the glucogenic amino acids aspartate (43%; P < 0.01), threonine (46%; P < 0.05), serine (46%; P < 0.02), glycine (47%; P < 0.01), and methionine (34%; P < 0.02). Fasting alanine levels decreased from 835 ± 236 to 393 ± 66 μM (P < 0.05). The 6-h glucagon infusion caused a 101 ± 14 mg/dl maximal plasma glucose increment in PX (n =8) vs. 33 ± 11 in 5 insulin-withdrawn type I diabetic patients serving as controls (P =0.022). Furthermore, when glucagon was infused at a higher rate (3 ng/kg-min) in 12 additional type I diabetic patients, the mean maximal plasma glucose increment (54 ± 15 mg/dl) was still less than half that in PX, despite a 3-fold higher infusion plasma glucagon level (326 ± 37 pg/ml). The 6-h glucagon infusion caused a significant decrease in the concentrations of glucogenic amino acids in the glucagon-deficient patients, but not in the type I diabetic patients. We conclude that 1) glucagon replacement in the PX patient markedly alters blood glucose and glucogenic amino acids, but not ketone levels; and 2) the metabolic response to glucagon is considerably more pronounced in PX patients than in type I diabetic patients. These data suggest that glucagon responsiveness is enhanced in the chronic hormone-deficient state. © 1986 by The Endocrine Society. |
| Keywords: | adult; clinical article; drug efficacy; pancreas resection; pancreas; metabolism; serine; pancreatectomy; insulin; glucose blood level; threonine; blood glucose; amino acids; insulin dependent diabetes mellitus; therapy; aspartic acid; methionine; glycine; intravenous drug administration; ketone; ketones; endocrine system; middle age; glucagon; human; male; female; priority journal; support, non-u.s. gov't; support, u.s. gov't, p.h.s.; glycosuria; diabetes mellitus, insulin-dependent |
| Journal Title: | Journal of Clinical Endocrinology and Metabolism |
| Volume: | 63 |
| Issue: | 2 |
| ISSN: | 0021-972X |
| Publisher: | Oxford University Press |
| Date Published: | 1986-08-01 |
| Start Page: | 439 |
| End Page: | 446 |
| Language: | English |
| DOI: | 10.1210/jcem-63-2-439 |
| PUBMED: | 3522619 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Export Date: 18 August 2021 -- Source: Scopus |
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