Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Effect of hyperglycaemia on gallbladder motility in Type 1 (insulin-dependent) diabetes mellitus

  • 101 Accesses

  • 26 Citations

Summary

Patients with diabetes mellitus are at increased risk of developing gallstones. This has been attributed, among other factors, to alterations in gallbladder motility in the presence of autonomic neuropathy. Since high blood glucose concentrations impair gastric emptying in diabetic patients, we have investigated the effect of acute hyperglycaemia on gallbladder motility. Seven Type 1 (insulin-dependent) diabetic patients were studied twice during euglycaemia (blood glucose 5 mmol/l) and hyperglycaemia (blood glucose 15 mmol/l) using a clamp technique. In addition, seven healthy volunteers were studied during euglycaemia and hyperglycaemia. Gallbladder volumes, measured with ultrasonography, were studied before and during infusion of step-wise increasing doses of cholecystokinin-33, 0.25, 0.5 and 1.0 Ivy Dog Unit · kg−1 · h−1, each dose for 30 min. Mean basal gallbladder volumes were not significantly different in the four experiments. Administration of cholecystokinin resulted in significant (p<0.05) dose-dependent reductions in gallbladder volume in all experiments. During euglycaemia the gallbladder contraction in diabetic patients was not significantly different from the control subjects. During hyperglycaemia the gallbladder contraction in the diabetic patients was significantly (p<0.05) reduced compared to euglycaemia only during infusion of 0.25 Ivy Dog Unit · kg−1 · h−1 of cholecystokinin (19±6% vs 33±6%). Compared to euglycaemia, during hyperglycaemia the gallbladder contraction in the control subjects was significantly (p<0.05) reduced during infusion of 0.25, 0.5 and 1.0 Ivy Dog Unit · kg−1 · h−1 of cholecystokinin (14±4% vs 31±3%; 42±6% vs 65±5%; 74±4% vs 90±3%, respectively). It is concluded that during euglycaemia the gallbladder contraction in response to cholecystokinin in Type 1 diabetic patients is not significantly different from control subjects. During hyperglycaemia the gallbladder contraction in response to 0.25 Ivy Dog Unit · kg−1 · h−1 cholecystokinin, leading to cholecystokinin levels as observed after ingestion of a light meal, is significantly reduced in Type 1 diabetic patients.

References

  1. 1.

    Lieber M (1952) The incidence of gallstones and their correlation with other diseases. Ann Surg 135: 394–404

  2. 2.

    Stone BG, van Thiel DH (1985) Diabetes mellitus and the liver. Semin Liver Dis 5: 8–28

  3. 3.

    Hayes PC, Patrick A, Roulston JE, et al. (1992) Gallstones in diabetes mellitus: prevalence and risk factors. Eur J Gastroenterol Hepatol 4: 55–59

  4. 4.

    Roslyn JJ, Pitt HA, Man LL, Ament ME, DenBesten L (1983) Gallbladder disease in patients on long-term parenteral nutrition. Gastroenterology 84: 148–154

  5. 5.

    Holan KR, Holzbach RT, Herman RE, Coopermann AM, Claffey WJ (1979) Nucleation time: a key factor in the pathogenesis of cholesterol gallstone disease. Gastroenterology 72: 611–617

  6. 6.

    Vogelberg KH, Kuebler HGW, Cicmir J, Rathman W (1984) Gallbladder contractility, cholelithiasis and autonomic neuropathy in diabetics. DMW 109: 1712–1715

  7. 7.

    Braverman DZ (1986) The lack of effect of metoclopramide on gallbladder volume and contraction in diabetic cholecystoparesis. Am J Gastroenterol 81: 960–962

  8. 8.

    Schreiner DP, Sarva RP, van Thiel DH, Yingvoparant N (1986) Gallbladder function in diabetic patients. J Nucl Med 27: 357–360

  9. 9.

    Stone BG, Gaveler J, Belle S, et al. (1988) Impairment of gallbladder emptying in diabetes mellitus. Gastroenterology 95: 170–176

  10. 10.

    Fiorucci S, Bosso R, Scionti L, et al. (1990) Neurohumoral control of gallbladder motility in healthy subjects and diabetic patients with or without autonomic neuropathy. Dig Dis Sci 35: 1089–1097

  11. 11.

    Keshavarian A, Dunne M, Iber LF (1987) Gallbladder volume and emptying in insulin requiring male diabetics. Dig Dis Sci 32: 824–828

  12. 12.

    MacGregor IL, Gueller R, Watts HD, Meyer JH (1976) The effect of acute hyperglycaemia on gastric emptying in man. Gastroenterology 70: 190–196

  13. 13.

    Horowitz M, Harding PE, Maddox AF, et al. (1989) Gastric and oesophageal emptying in patients with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 32: 151–159

  14. 14.

    Fraser RJ, Horowitz M, Maddox AF, Harding PE, Chatterton BE, Dent J (1990) Hyperglycaemia slows gastric emptying in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 33: 675–680

  15. 15.

    Øster-Jörgensen E, Pedersen SA, Larsen ML (1990) The influence of induced hyperglycaemia on gastric emptying in healthy humans. Scand J Clin Lab Invest 50: 831–836

  16. 16.

    De Boer SY, Masclee AAM, Jebbink MCW, et al. (1990) Effect of acute hyperglycaemia on gallbladder contraction induced by cholecystokinin in humans. Gut 34: 1123–1127

  17. 17.

    Ewing DJ, Clarke BF (1986) Autonomic neuropathy: its diagnosis and prognosis. Clin Endocrinol Metab 15: 855–888

  18. 18.

    DeFronzo RA, Tobin JD, Andres R (1979) Glucose clamp technique for quantifying insulin secretion and resistance. Am J Physiol 237: E214-E223

  19. 19.

    Hopman WPM, Kerstens PJSM, Jansen JBJM, Rosenbusch G, Lamers CBHW (1985) Effect of graded physiologic doses of cholecystokinin on gallbladder contraction measured by ultrasonography. Gastroenterology 89: 1242–1247

  20. 20.

    Everson GT, Braverman DJ, Johnson ML, Kern F (1980) A critical evaluation of real-time ultrasonography for the study of gallbladder volume and contraction. Gastroenterology 79: 40–46

  21. 21.

    Hopman WPM, Brouwer WFM, Rosenbusch G, et al. (1985) A computerized method for rapid quantification of gallblader volume from real-time sonograms. Radiology 154: 236–237

  22. 22.

    Jansen JBJM, Lamers CBHW (1983) Radioimmunoassay of cholecystokinin in human tissue and plasma. Clin Chim Acta 131: 305–316

  23. 23.

    Jansen JBMJ, Lamers CBHW (1987) Molecular forms of cholecystokinin in plasma from normals and gastrectomized human subjects following a fat meal. Peptides 8: 801–805

  24. 24.

    Lamers CBHW, Diemel JM, van Leer E, van Leusen R, Peetoom J (1982) Mechanism of elevated serum pancreatic polypeptide concentration in chronic renal failure. J Clin Endocrinol Metab 55: 922–926

  25. 25.

    Nijs HGT, Radder JK, Fröhlich M, Krans HMJ (1990) In vivo relation between insulin clearance and insulin action in healthy subjects and insulin-dependent diabetic patients. Diabetes 39: 333–339

  26. 26.

    Bloom AA, Hackenfeld R (1969) Diabetic cholescintigraphy. JAMA 208: 357–359

  27. 27.

    De Boer SY, Masclee AAM, Lam WF, Lamers CBHW (1992) Effect of acute hyperglycaemia on esophageal motility and lower esophageal sphincter pressure in humans. Gastroenterology 103: 775–780

  28. 28.

    MacGregor IL, Deveney C, Way LW, Meyer JH (1976) The effect of acute hyperglycaemia on meal-stimulated gastric, biliary, and pancreatic secretion, and serum gastrin. Gastroenterology 70: 197–202

  29. 29.

    Niederau C, Sonnenberg A, Erckenbrecht J (1985) Effects of intravenous infusion of amino acids, fat or glucose on unstimulated pancreatic secretion in healthy humans. Dig Dis Sci 30: 445–455

  30. 30.

    Bueno L, Ruckebusch M (1987) Insulin and jejunal electrical activity in dog and sheep. Am J Gastroenterol 82: 840–843

  31. 31.

    Lee KY, Zhuo L, Ren XS, Chang TM, Chey WY (1990) An important role of endogenous insulin on exocrine pancreatic secretion in rats. Am J Physiol 258: G268-G274

  32. 32.

    Taylor I, Duthie HL, Cumberland DC, Smallwood R (1975) Glucagon and the colon. Gut 16: 973–978

  33. 33.

    Hopman WPM, Jansen JBMJ, Rosenbusch G, Lamers CBHW (1990) Role of cholecystokinin and the cholinergic system in intestinal stimulation of gallbladder contraction in man. Hepatology 11: 261–265

  34. 34.

    Hirano T, Niijima A (1980) Effects of 2-deoxy-d-glucose, glucose and insulin on efferent activity in gastric vagus nerve. Experientia 36: 1197–1198

  35. 35.

    Marco J, Hedo JA, Castillo-Olivares J, Villanueva ML (1980) Human pancreatic polypeptide secretion in conditions of exogenous and endogenous hyperglycaemia. Diabetologia 19: 418–422

  36. 36.

    Schwartz TW, Stenquist B, Olbe L (1979) Cephalic phase of pancreatic polypeptide secretion studied by sham feeding in man. Scand J Gastroenterol 14: 313–320

  37. 37.

    Tsuda K, Seino Y, Mori K, et al. (1981) Effect of truncal vagotomy on pancreatic polypeptide responses after intravenous glucose administration. Regul Rept 1: 347–352

  38. 38.

    Kennedy FP (1988) Pathophysiology of pancreatic polypeptide secretion in human diabetes mellitus. Diabetes, Nutrition and Metabolism 2: 155–163

  39. 39.

    Rasmussen MH, List S, Schwartz TW, Hilsted J (1990) Pancreatic polypeptide response to a meal is independent of glycaemic control. Diabetologia 33: A162 (Abstract)

Download references

Author information

Correspondence to A. A. M. Masclee.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

de Boer, S.Y., Masclee, A.A.M., Lam, W.F. et al. Effect of hyperglycaemia on gallbladder motility in Type 1 (insulin-dependent) diabetes mellitus. Diabetologia 37, 75–81 (1994). https://doi.org/10.1007/BF00428781

Download citation

Key words

  • Gallbladder emptying
  • hyperglycaemia
  • cholecystokinin
  • Type 1 (insulin-dependent) diabetes mellitus
  • autonomic neuropathy