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Glukosetoleranz und insulinsekretion bei oraler und intravenöser glukosebelastung nach intraabdominellen operationen

Glucose tolerance and insulin secretion in oral and intravenous glucose load after intraabdominal operation

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Summary

The insulin secretion in the peripheral venous blood and the portal venous blood were measured during 14 oral glucose tolerance tests (OGT) and 12 glucose infusion tests (GIT), in 19 patients after intraabdominal operations. 8 OGTs and 6 GITs were carried out on the 6th reap. 7th postoperative day, whilst 6 OGTs and GITs were carried out 12 days after the operation. The following conclusions can be drawn:

  1. 1.

    After intraabdominal operation the glucose tolerance is still considerably less on the 7th postoperative day.

  2. 2.

    The insulin concentrations in the peripheral venous blood are nearly identical on the 6th/7th and the 12th postoperative day.

  3. 3.

    Contrary to this, clear differences were measured in the portal venous blood. During the OGTs the insulin concentrations in the early postoperative period - 7th postoperative day -are higher than in the later postoperative period -12th postoperative day. The insulin concentration during the GITs on the other hand are lower in the early postoperative period than later postoperatively.

  4. 4.

    It is discussed, whether the influence of enteral factors as well as an increased permeability of the liver for the instantly resorbed glucose - the result is an increased hyperglycemical stimulus for the insular cell apparatus - is the cause for the high plasma insulin level after oral glucose application.

  5. 5.

    Because the glucose tolerance is diminished inspite of high insulin level during oral glucose application, the enlargement of the glucose pool by glycogenolysis and gluconeogenesis in the early postoperative period must be accepted as the most probable cause.

Zusammenfassung

Die Insulinsekretion im peripheren Venenblut und Pfortaderblut wurden während 14 oraler Glukosebelastungstests (OGT) und 12 Glukoseinfusionstests (GIT) bei 19 Patienten nach intraabdominellen Operationen gemessen. 8 OGTs und 6 GITs wurden am 6. bzw. 7. postoperativen Tag durchgeführt, während jeweils 6 OGTs und GITs 12 Tage nach der Operation erfolgten. Folgende Schlußfolgerungen werden gezogen:

  1. 1.

    Nach intraabdominellen Operationen ist die Glukosetoleranz noch am 7. postoperativen Tag wesentlich gemindert.

  2. 2.

    Die Insulinkonzentrationen im peripher venösen Blut sind am 6./7. postoperativen Tag und am 12. postoperativen Tag nahezu identisch.

  3. 3.

    Im Gegensatz dazu werden im Pfortaderblut deutliche Unterschiede gemessen. Während der OGTa sind die Ineulinkonzentrationen früher postoperativ (7. postoperativer Tag) höher als später postoperativ (12. postoperativer Tag). Umgekehrt sind die Insulinkonzentrationen während der GITs früh postoperativ niedriger als spät postoperativ.

  4. 4.

    Als Ursache der hohen Plasmainsulinspiegel nach oraler Glukosegabe wird der Einfluß enteraler Faktoren sowie eine erhöhte „Durchlässigkeit” der Leber für die unmittelbar resorbierte Glukose - Folge ist ein stärkerer hyperglykämischer Reiz für den Inselzellapparat -in der frühen postoperativen Phase diskutiert.

  5. 5.

    Da trotz hoher Insulinspiegel bei oraler Glukosegabe die Glukosetoleranz vermindert ist, muß als Ursache am ehesten die Vergrößerung des Glukosepools durch Glykogenolyse und Glukoneogenese in der frühen postoperativen Phase angenommen werden.

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Literatur

  1. Amatuzio, D. S., Stutzman, F. L., Vanderbilt, M. J., Nesbitt, S.: Interpretation of the rapid intravenous glucose tolerance test in normal individuals and in mild diabetes mellitus. J. clin. Invest.32, 428–435 (1953)

    Google Scholar 

  2. Anderson, E., Long, J. A.: The effect of hyperglycemia on insulin secretion as determined with the isolated rat pancreas in a perfusion apparatus. Endocrinology40, 92–97 (1947)

    Google Scholar 

  3. Beger, H. G., Bittner, R., Krass, E., Gerhards, F.: Der Einfluß von Gastrin auf die Insulinsekretion. Langenbecks Arch. Chir., Suppl. Chir. Forum 1973, 37

  4. Carey, L. C., Lowery, B. D., Cloutier, C. T.: Blood sugar and insulin response of humans in shock. Ann. Surg.172, 342–347 (1970)

    Google Scholar 

  5. Cerchio, G. M., Persico, P. A., Jeffay, H.: Inhibition of insulin release during hypovolemic shock. Metabolism22, 1449–1458 (1973)

    Google Scholar 

  6. Creutzfeldt, W.: The relationship between aetiological and promoting factors in the pathogenesis of diabetes mellitus in man and animals. Acta diabet. lat.7 (Suppl. 1), 341–359 (1970)

    Google Scholar 

  7. Creutzfeldt, W., Feurle, G., Ketterer, H.: Effect of gastrointestinal hormones on insulin and glucagon secretion. New Engl. J. Med.282, 1139–1141 (1970)

    Google Scholar 

  8. Dupre, J., Curtis, J. D., Unger, R. H., Waddell, R. W., Beck, J. C.: Effects of secretin, pancreozymin, or gastrin on the response of the endocrine pancreas to administration of glucose or arginine in man. J. clin. Invest.48, 745–757 (1969)

    Google Scholar 

  9. Eisele, R., Beger, H. G., Kintzonidis, D., Nasseri, M., Bücherl, E. S.: Die langfristige Katheterisierung des Pfortadergefäßsystems nach abdominellen Operationen beim Menschen. Z. ges. exp. Med. exp. Chir.149, 356–358 (1969)

    Google Scholar 

  10. Grodsky, G. M., Batts, A. A., Bennett, L. L., Vcella, C., McWilliams, N. B., Smith, D. F.: Effects of carbohydrates on secretion of insulin from isolated rat pancreas. Amer. J. Physiol.205, 638–644 (1963)

    Google Scholar 

  11. Hales, C. N., Randle, P. J.: Immunoassay of insulin with insulin-antibody precipitate. Biochem. J.88, 137–146 (1963)

    Google Scholar 

  12. Hayes, M. A., Brandt, R. L., Arbor, A.: Carbohydrate metabolism in the immediate postoperative period. Surgery32, 819–827 (1952)

    Google Scholar 

  13. Hiebert, J. M., McCormick, J. M., Egdahl, R. H.: Direct measurement of insulin secretory rate: Studies in shocked primates and postoperative patients. Ann. Surg.176, 296–304 (1972)

    Google Scholar 

  14. Hinton, P., Allison, S. P., Littlejohn, S., Lloyd, J.: Insulin and glucose to reduce catabolic response to injury in burned patients. Lancet 19711 767–769

    Google Scholar 

  15. Ikkos, D., Luft, R.: On the intravenous glucose tolerance test. Acta endocr. (Kbh.)25, 312–334 (1957)

    Google Scholar 

  16. Jordan, G. L., jr., Fischer, E. P., Lefrak, E. A.: Glucose metabolism in traumatic shock in the human. Ann. Surg.175, 685–692 (1972)

    Google Scholar 

  17. Kipnis, D. M.: Insulin secretion in normal and diabetic individuals. Advanc. intern. Med.16, 103–134 (1970)

    Google Scholar 

  18. Kraas, E., Bittner, R., Roscher, R., Beger, H. G.: The relationship between glucose utilization and insulin-secretory-rate after abdominal surgery in man. Vortrag, 9. Congr. Europ. Soc. Exp. Surgery, Salzburg 1974

  19. Lindseth, R. E.: Postoperative glucose metabolism in diabetic and nondiabetic patients. Arch. Surg.105, 741–745 (1972)

    Google Scholar 

  20. Long, C. L., Spencer, J. L., Kinney, J. M., Geiger, J. W.: Carbohydrate metabolism in man: effect of elective operations and major injury. J. appl. Physiol.31, 110–116 (1971)

    Google Scholar 

  21. Madison, L. L., Unger, R. H.: The physiologic significance of the secretion of endogenous insulin into the portal circulation. I. Comparison of the effects of glucagon-free insulin administered via the portal vein and via a peripheral vein on the magnitude of hypoglycemia and peripheral glucose utilization. J. clin. Invest.12, 631–639 (1958)

    Google Scholar 

  22. McIntyre, N., Holdsworth, C. D., Turner, D. S.: Intestinal factors in the control of insulin secretion. J. clin. Endocr.25, 1317–1324 (1965)

    Google Scholar 

  23. Ross, H., Johnston, I. D. A., Welborn, T. A., Wright, A. D.: Effect of abdominal operation on glucose tolerance and serum levels of insulin, growth hormone, and hydrocortisone Lancet1966 II, 563–566

    Google Scholar 

  24. Samols, E., Marri, G., Marks, V.: Promotion of insulin secretion by glucagon. Lancet1965 II, 415–416

    Google Scholar 

  25. Schmidt, F. H.: Enzymatische Methoden zur Bestimmung von Blut- und Harnzucker unter Berücksichtigung von Vergleichsuntersuchungen mit klassischen Methoden. Internist4, 554–559 (1963)

    Google Scholar 

  26. Seltzer, H. S., Allen, E. W., Herron, A. L., jr., Brennan, M. T.: Insulin secretion in response to glycemic stimulus: Relation of delayed initial release to carbohydrate intolerance in mild diabetes mellitus. J. clin. Invest.46, 323–335 (1967)

    Google Scholar 

  27. Unger, R. H., Eisentraut, A. M.: Entero-insular axis. Arch. intern. Med.123, 261–266 (1969)

    Google Scholar 

  28. Unger, R. H., Ketterer, H., Dupré, J., Eisentraut, A. M.: The effects of secretin, pancreozymin, and gastrin on insulin and glucagon secretion in anesthetized dogs. J. clin. Invest.46, 630–645 (1967)

    Google Scholar 

  29. Welborn, T. A., Rubenstein, A. H., Haslam, R., Fraser, R.: Normal insulin response to glucose. Lancet1966 I, 280–284

    Google Scholar 

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Authors and Affiliations

  1. Gastroenterologische Arbeitsgruppe Chirurgische Univ.-Klinik im Klinikum Westend, Spandauer Damm 130, D-1000, Berlin 19, Germany

    R. Bittner,  H. G. Beger,  E. Kraas &  R. Roscher

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  1. R. Bittner
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  2. H. G. Beger
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  3. E. Kraas
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  4. R. Roscher
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Bittner, R., Beger, H.G., Kraas, E. et al. Glukosetoleranz und insulinsekretion bei oraler und intravenöser glukosebelastung nach intraabdominellen operationen. Langenbecks Arch Chiv 338, 43–54 (1975). https://doi.org/10.1007/BF01302725

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  • DOI: https://doi.org/10.1007/BF01302725

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