Glucagon, catecholamine, and symptom responses to hypoglycemia in living donors of pancreas segments.
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 alpha-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.
Robertson
R Paul
RP
Pacific Northwest Research Institute, University of Washington, Seattle 98122, USA. rpr@u.washington.edu
Sutherland
David E R
DE
Seaquist
Elizabeth R
ER
Lanz
Karla J
KJ
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D004837:Epinephrine / Q000097:blood* / Q000378:metabolism; D005215:Fasting; D005260:Female; D005934:Glucagon / Q000097:blood* / Q000378:metabolism; D015309:Glucose Clamp Technique; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000097:blood; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood* / Q000378:metabolism; D010180:Pancreatectomy / Q000379:methods
D001786:Blood Glucose; D004837:Epinephrine; D005934:Glucagon; D006442:Glycated Hemoglobin; D007328:Insulin; D009638:Norepinephrine