PMID- 29351616
OWN - NLM
STAT- MEDLINE
DCOM- 20181010
LR  - 20210511
IS  - 1945-7197 (Electronic)
IS  - 0021-972X (Print)
IS  - 0021-972X (Linking)
VI  - 103
IP  - 4
DP  - 2018 Apr 1
TI  - Deficient Glucagon Response to Hypoglycemia During a Mixed Meal in Total 
      Pancreatectomy/Islet Autotransplantation Recipients.
PG  - 1522-1529
LID - 10.1210/jc.2017-02182 [doi]
AB  - CONTEXT: Total pancreatectomy and intrahepatic islet autotransplantation (TP/IAT) 
      is performed to alleviate severe abdominal pain, avoid narcotic use, maintain 
      islet function, and avoid diabetes in patients with chronic pancreatitis. 
      However, many TP/IAT recipients complain of postprandial hypoglycemia. OBJECTIVE: 
      This study was designed to discover the mechanisms of this problem. DESIGN: 
      Participants consumed a triple-isotope mixed meal. SETTING: This study was 
      performed in a hospital research unit. PARTICIPANTS: We studied 10 TP/IAT 
      recipients and 10 age- and body mass index-matched control subjects. Seven of 10 
      recipients had a history of postprandial hypoglycemia. INTERVENTIONS: 
      Participants were given a [1-13C]-labeled mixed meal and two tracer infusions 
      ([6,6-2H2]- and [6-3H]-glucose). MAIN OUTCOME MEASURES: Glucose kinetics and 
      concentrations of regulatory hormones were determined. RESULTS: Immediately after 
      the meal, peak glucose was elevated in recipients compared with control subjects 
      [266 +/- 20 mg/dL (14.8 +/- 1.1 mmol/L) vs 185 +/- 13 mg/dL (10.3 +/- 0.7 mmol/L); P = 
      0.01]. However, mean Delta glucose for TP/IAT recipients between minutes 240 and 360 
      postprandially was significantly lower than for control subjects (P < 0.05); six 
      of the seven recipients with a history of hypoglycemia experienced abnormally low 
      postprandial Delta glucose. Delta Glucagon remained unchanged (minutes 240 to 360; P = 
      0.58) in TP/IAT recipients despite abnormal decreases in postprandial glucose. 
      Radioisotopic studies revealed that meal appearance, glucose disappearance, and 
      endogenous glucose production in TP/IAT recipients were not different from 
      control subjects. CONCLUSION: Initially high glucose levels followed by 
      hypoglycemia with an absent glucagon response is a mechanistic sequence that 
      contributes to postprandial hypoglycemia after TP/IAT.
FAU - Bogachus, Lindsey D
AU  - Bogachus LD
AD  - Pacific Northwest Diabetes Research Institute, Seattle, Washington.
AD  - Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, 
      University of Washington, Seattle, Washington.
FAU - Bellin, Melena D
AU  - Bellin MD
AD  - Department of Medicine and Pediatrics, Division of Diabetes, Endocrinology, and 
      Metabolism, University of Minnesota, Minneapolis, Minnesota.
FAU - Vella, Adrian
AU  - Vella A
AD  - Mayo Clinic College of Medicine, Division of Endocrinology, Diabetes, and 
      Metabolism, Rochester, Minnesota.
FAU - Robertson, R Paul
AU  - Robertson RP
AD  - Pacific Northwest Diabetes Research Institute, Seattle, Washington.
AD  - Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, 
      University of Washington, Seattle, Washington.
AD  - Department of Medicine and Pediatrics, Division of Diabetes, Endocrinology, and 
      Metabolism, University of Minnesota, Minneapolis, Minnesota.
LA  - eng
GR  - R01 DK078646/DK/NIDDK NIH HHS/United States
GR  - R01 DK116231/DK/NIDDK NIH HHS/United States
GR  - T32 DK007203/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Clin Endocrinol Metab
JT  - The Journal of clinical endocrinology and metabolism
JID - 0375362
RN  - 0 (Blood Glucose)
RN  - 9007-92-5 (Glucagon)
SB  - IM
MH  - Adult
MH  - Blood Glucose/*metabolism
MH  - Female
MH  - Glucagon/*blood
MH  - Humans
MH  - Hypoglycemia/*blood
MH  - Islets of Langerhans Transplantation/*methods
MH  - Male
MH  - Meals
MH  - Middle Aged
MH  - *Pancreatectomy
MH  - Pancreatitis, Chronic/blood/*surgery
MH  - Postprandial Period/physiology
MH  - Transplantation, Autologous
PMC - PMC6276676
EDAT- 2018/01/20 06:00
MHDA- 2018/10/12 06:00
PMCR- 2019/04/01
CRDT- 2018/01/20 06:00
PHST- 2017/10/02 00:00 [received]
PHST- 2018/01/12 00:00 [accepted]
PHST- 2018/01/20 06:00 [pubmed]
PHST- 2018/10/12 06:00 [medline]
PHST- 2018/01/20 06:00 [entrez]
PHST- 2019/04/01 00:00 [pmc-release]
AID - 4815706 [pii]
AID - jcem_201702182 [pii]
AID - 10.1210/jc.2017-02182 [doi]
PST - ppublish
SO  - J Clin Endocrinol Metab. 2018 Apr 1;103(4):1522-1529. doi: 10.1210/jc.2017-02182.