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Effect of hemipancreatectomy and of pancreatic diversion on the tolerance to a glucose load in humans.

Abstract：

BACKGROUND:The role of the pattern, quantity and site of insulin secretion in the tolerance to a glucose challenge is not fully evaluated in humans because it is difficult to obtain appropriate clinical models. DESIGN:To address this issue, we studied subjects with reduced pancreatic mass (hemipancreatectomized, HEMI), systemic insulin delivery (pancreas transplant recipients, PTX), and two control groups (healthy, CON; and with uveitis on the same immunosuppression as PTX, UVE), with an hyperglycaemic clamp (study 1, + 4.2 mmol L-1), using a repeat experiment (study 2) with a fixed glucose infusion, calculated to increase by 35% that in study 1. RESULTS:In study 1, CON increased glucose uptake to 20 +/- 3 micromol kg-1 min-1 after a biphasic insulin response. In study 2, CON further increased the glucose uptake via an increment in prehepatic insulin secretion that stimulated insulin sensitivity without changes in peripheral insulin and glucose concentrations. HEMI and PTX had 35% less glucose uptake in study 1, compared to CON, and increased glucose concentrations (+ 1.6 mmol L-1) in study 2. UVE had an intermediate defect. The causes of intolerance were different: HEMI had a defective first-phase insulin secretion (50% peripheral insulin concentrations) but maintained insulin sensitivity; PTX had normal peripheral insulin but only one-third of the insulin sensitivity of CON. CONCLUSIONS:Hemipancreatectomy and systemic insulin delivery impair first-phase insulin secretion; second-phase peripheral insulinization (HEMI); insulin sensitivity (PTX); and a mechanism evidentiated in study 2 of CON that increases insulin sensitivity in response to prehepatic insulin secretion (both groups). Failure of these mechanisms is largely compensated by hyperglycaemia.

journal_name

Eur J Clin Invest

journal_title

European journal of clinical investigation

authors

Battezzati A,Zerbi A,Perseghin G,Caumo A,Terruzzi I,Di Carlo V,Luzi L

doi

10.1046/j.1365-2362.2000.00648.x

keywords:

subject

Has Abstract

pub_date

2000-05-01 00:00:00

pages

397-410

issue

eissn

0014-2972

issn

1365-2362

pii

eci648

journal_volume

pub_type

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Effect of hemipancreatectomy and of pancreatic diversion on the tolerance to a glucose load in humans.