title: Abnormal alpha cell hypoglycemic recognition in children with insulin dependent diabetes mellitus (IDDM).
abstract: Children with IDDM have diminished glucagon responses to hypoglycemia. We evaluated possible mechanisms in 60 children and adolescents with IDDM (age 15.4 +/- 2.6 years, duration 7.8 +/- 3.5 years [mean +/- SD]) and without diabetic complications. These were: 1) suppression by hyperinsulinism, 2) autonomic neuropathy, 3) a pan-islet cell defect, and 4) a glucotoxic effect. Glucagon and pancreatic polypeptide responses to hypoglycemia (insulin bolus 0.15-0.75 U/kg) were studied after insulin withdrawal and 3 days of intensive insulin therapy. Responses to arginine and mixed meal were also studied. The control group consisted of children with non-growth hormone deficient short stature. IDDM children had lower glucagon responses to hypoglycemia than controls (p < 0.001), the response to arginine did not differ from controls, and was greater than the response to hypoglycemia (p < 0.001). Responses to hypoglycemia after insulin withdrawal and intensive therapy did not differ. Basal pancreatic polypeptide levels were lower in IDDM than in controls (p < 0.05) but responses to hypoglycemia did not differ between groups. Thus the diminished glucagon response to hypoglycemia reflects a defect in hypoglycemic recognition or response by the alpha cells.
authors: Department of Pediatrics, University of Pittsburgh.
authors: R P
authors: RP
authors: Hoffman
authors: C
authors: C
authors: Singer-Granick
authors: A L
authors: AL
authors: Drash
authors: D J
authors: DJ
authors: Becker
mesh_terms: D000293:Adolescent; D001120:Arginine; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000503:physiopathology; D005260:Female; D005502:Food; D005934:Glucagon / Q000097:blood; D006706:Homeostasis; D006801:Humans; D007003:Hypoglycemia / Q000503:physiopathology*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D007515:Islets of Langerhans / Q000503:physiopathology*; D008297:Male; D010191:Pancreatic Polypeptide / Q000097:blood
chemical_list: D007328:Insulin; D010191:Pancreatic Polypeptide; D005934:Glucagon; D001120:Arginine