Using the glucagon test to predict hypoglycemia in anorexia nervosa.
BACKGROUND
Hypoglycemia is an important but uncommon complication of anorexia nervosa (AN) that usually occurs when refeeding begins. The response to an iv bolus of glucagon has been used to investigate hypoglycemia, but not in AN. There are no published standards in AN to screen for hypoglycemia, to treat hypoglycemia, or for the response of the fasting blood sugar to an intravenous bolus of glucagon.


METHODS
We report the change in blood glucose that resulted from bolus iv injection of glucagon in a case series of 9 patients with AN who were suspected of having experienced hypoglycemia. Our standard protocol for the glucagon test in AN is measurement of blood sugar at baseline, 10 minutes, and 20 minutes following a 1.0 mg iv bolus of glucagon in the fasting state. We take as normal any blood glucose measurement of 7.0 mmol/l or greater.


RESULTS
Five of nine patients had abnormal tests. The body mass index (BMI) was not different in those who had normal compared to those who had abnormal tests.


CONCLUSIONS
The glucagon test may be of use to predict the likelihood of developing hypoglycemia in AN. However, a larger study is required to define the normal response to the glucagon test in AN.
Puddicombe
D M
DM
Eating Disorders Program, St. Paul's Hospital, Vancouver, British Columbia, Canada, V6Z 1Y6.
Birmingham
C L
CL
D000328:Adult; D000856:Anorexia Nervosa / Q000150:complications*; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D005260:Female; D005934:Glucagon / Q000008:administration & dosage; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis* / Q000209:etiology*; D008099:Liver / Q000378:metabolism; D011237:Predictive Value of Tests
D001786:Blood Glucose; D005934:Glucagon