Abstract
We previously reported that patients with idiopathic reactive hypoglycemia (plasma glucose concentration lower than 2.5 mmol/L 2–4 h after the ingestion of 75 g of glucose) display reduced or absent counterregulatory response of the glucagon secretion and increased insulin sensitivity. In order to examine the effect of glucagon on the increased insulin sensitivity in these patients, 12 subjects with idiopathic reactive hypoglycemia underwent a two-step hyperinsulinemic (1 mU/kg.min) euglycemic glucose clamp and were compared with 12 normal control subjects matched for age, weight and sex. During the first step of the glucose clamp (only insulin + glucose infusion) the patients with Idiopathic Reactive Hypoglycemia required higher glucose infusion rates to maintain euglycemia than normal subjects (9.09 ± 0.29 mg/kg.min vs 7.61 mg/kg.min). When basal glucagon secretion was replaced (+ somatostatin and glucagon, second step of the clamp) the glucose infusion rates required to maintain euglycemia in patients with Idiopathic Reactive Hypoglycemia significantly decreased (to 7.17 ± 0.40 mg/kg.min) and resulted similar to normal subjects (7.64 ± 0.41 mg/kg.min). Thus, in patients affected by Idiopathic Reactive Hypoglycemia, glucagon secretion may play an important role in the pathogenesis of the increased insulin sensitivity and hypoglycemia.
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References
Lev-Ran A., Anderson R.W. The diagnosis of postprandial hypoglycemia. Diabetes 30: 996, 1981.
Lefebvre P.J. Statement on “Post-Prandial” or “Reactive” hypoglycemia. Diabetologia 31: 68, 1988.
Luyckx A.S., Lefebvre P.J. Plasma insulin in reactive hypoglycemia. Diabetes 20: 435, 1971.
Foà P.P., Dunbar J.C., Klein S.P., Levy S.H., Malik M.A., Campbell B.B., Foà N.L. Reactive hypoglycemia and A-cell (‘pancreatic’) glucagon deficiency in the adult. JAMA 244: 2281, 1980.
Vexiau P., Legoff B., Cathelineau G. Insulin, Cortisol secretion during OGTT in patients with reactive hypoglycemia with or without clinical symptoms. Horm. Metab. Res. 75: 419, 1983.
Hofeldt F.D., Lufkin E.G., Hagler L. Are abnormalities in insulin secretion responsible for reactive hypoglycemia? Diabetes 23: 589, 1974.
Tamburrano G., Leonetti F., Sbraccia P., Giaccari A., Locuratolo N., Lala A. Increased insulin sensitivity in patients with idiopathic reactive hypoglycemia. J. Clin. Endocrinol. Metab. 69: 885, 1989.
Myers S.R., Diamond M.P., Adkins Marshall B.A., Williams P.E., Stinsen R., Cherrington A.D. Effects of small changes in glucagon on glucose production during a euglycemic, hyperinsulinemic clamp. Metabolism 40: 66, 1991.
Liljenquist J.E., Mueller G.L., Cherrington A.D., Keller U., Chiasson J.L., Perry J.M., Lacy W.W., Rabinowitz D. Evidence for an important role of glucagon in the regulation of hepatic glucose production in normal man. J.Clin. Invest. 59: 369, 1977.
FeFronzo R.A., Tobin J.D., Andres R. Glucose clamp technique; a method for quantifying insulin secretion and resistance. Am. J. Physiol. 237: E214, 1979.
Pozefsky T., Tancredi R.G., Moxley R.T., Dupre J., Tobin J.D. Metabolism of forearm tissues in man — studies with glucagon. Diabetes 25: 128, 1976.
Schneider S.H., Fineberg S.E., Blackburn G.L. The acute metabolic effects of glucagon and its interactions with insulin in forearm tissue. Diabetologia 20: 616, 1981.
Nosadini R., Del Prato S., Tiengo A., Duner E., Toffolo G., Cobelli C., Faronato P.P., Moghetti P., Muggeo M. Insulin sensitivity, binding, and kinetics in pancre-atogenic and Type I diabetes. Diabetes 30: 346, 1982.
Del Prato S., Tiengo A., Baccaglini U., Tremolada C., Duner E., Marescotti M.C., Avogaro A., Valverde I., Nosadini R., Assan R. Effect of insulin replacement on intermediary metabolism in diabetes secondary to pancreatectomy. Diabetologia 25: 252, 1983.
Del Prato S., Castellino P., Simonson D.C., De Fronzo R.A. Hyperglucagonemia and insulin-mediated glucose metabolism. J. Clin. Invest. 79: 547, 1987.
Jaffe B.J., Behrman H.R. Methods of radioimmunoassays. Academic Press, 1974.
Hofeld F.D. Reactive hypoglycemia. Endocrinol. Metab. Clin. North Am. 18: 185, 1989.
Jung Y., Khurana R.C., Corredor D.G., Hastillo A., Lain R.F., Patrick D., Turkeltaub P., Danowski T.S. Reactive hypoglycemia in women. Diabetes 20: 428, 1971.
Rehfeld J.F., Heding L.G., Holst J.J. Increased gut glucagon release as pathogenic factor in reactive hypoglycemia. Lancet 2: 116, 1973.
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Leonetti, F., Morviducci, L., Giaccari, A. et al. Idiopathic reactive hypoglycemia: a role for glucagon?. J Endocrinol Invest 15, 273–278 (1992). https://doi.org/10.1007/BF03348727
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DOI: https://doi.org/10.1007/BF03348727