TY - JOUR
T1 - Glucagon, catecholamine, and symptom responses to hypoglycemia in living donors of pancreas segments
AU - Robertson, R. Paul
AU - Sutherland, David E.R.
AU - Seaquist, Elizabeth R.
AU - Lanz, Karla J.
PY - 2003/7/1
Y1 - 2003/7/1
N2 - Donors undergoing hemi-pancreatectomy to provide a pancreas segment for transplantation into a relative with type 1 diabetes acquire diminished insulin and glucagon responses to intravenous agonists. Some donors develop diabetes and require treatment for hyperglycemia. They become at risk for hypoglycemia when treatment includes sulfonylureas and insulin. However, no studies assessing the impact of hemi-pancreatectomy in humans on islet α-cell responses to hypoglycemia have been reported. Consequently, we performed stepped hypoglycemic clamps in 7 donors of varying glycemic control and compared their responses to 16 control subjects. Donors and control subjects reached similar nadirs of glycemia (45 ± 3 and 41 ± 1 mg/dl, respectively) during the clamp. The donors had significantly higher mean basal glucagon levels than control subjects (203 ± 27 vs. 135 ± 15 pg/ml; P < 0.03) but did not have significant differences in glucagon responses during the clamp. The donors also had significantly higher mean peak epinephrine responses during the clamp (1,231 ± 134 vs. 730 ± 68 pg/ml; P < 0.002), but there were no statistically significant differences in norepinephrine or symptom responses. The glucose thresholds at which hormonal and symptom responses began were not different. We conclude that although glucagon response to arginine and insulin response to glucose and arginine are diminished after hemi-pancreatectomy, no deficiency in glucagon responses were detected during hypoglycemia.
AB - Donors undergoing hemi-pancreatectomy to provide a pancreas segment for transplantation into a relative with type 1 diabetes acquire diminished insulin and glucagon responses to intravenous agonists. Some donors develop diabetes and require treatment for hyperglycemia. They become at risk for hypoglycemia when treatment includes sulfonylureas and insulin. However, no studies assessing the impact of hemi-pancreatectomy in humans on islet α-cell responses to hypoglycemia have been reported. Consequently, we performed stepped hypoglycemic clamps in 7 donors of varying glycemic control and compared their responses to 16 control subjects. Donors and control subjects reached similar nadirs of glycemia (45 ± 3 and 41 ± 1 mg/dl, respectively) during the clamp. The donors had significantly higher mean basal glucagon levels than control subjects (203 ± 27 vs. 135 ± 15 pg/ml; P < 0.03) but did not have significant differences in glucagon responses during the clamp. The donors also had significantly higher mean peak epinephrine responses during the clamp (1,231 ± 134 vs. 730 ± 68 pg/ml; P < 0.002), but there were no statistically significant differences in norepinephrine or symptom responses. The glucose thresholds at which hormonal and symptom responses began were not different. We conclude that although glucagon response to arginine and insulin response to glucose and arginine are diminished after hemi-pancreatectomy, no deficiency in glucagon responses were detected during hypoglycemia.
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U2 - 10.2337/diabetes.52.7.1689
DO - 10.2337/diabetes.52.7.1689
M3 - Article
C2 - 12829634
AN - SCOPUS:0037677703
SN - 0012-1797
VL - 52
SP - 1689
EP - 1694
JO - Diabetes
JF - Diabetes
IS - 7
ER -