Effect of hemipancreatectomy and of pancreatic diversion on the tolerance to a glucose load in humans

A. Battezzati, A. Zerbi, G. Perseghin, A. Caumo, I. Terruzzi, V. Di Carlo, Livio Luzi

Research output: Contribution to journalArticle

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Abstract

Background. The role of the pattern, quantity and site of insulin secretion in the tolerance to a glucose challenge is not fully evaluated in humans because it is difficult to obtain appropriate clinical models. Design. To address this issue, we studied subjects with reduced pancreatic mass (hemipancreatectomized, HEMI), systemic insulin delivery (pancreas transplant recipients, PTX), and two control groups (healthy, CON; and with uveitis on the same immunosuppression as PTX, UVE), with an hyperglycaemic clamp (study 1, + 4.2 mmol L-1), using a repeat experiment (study 2) with a fixed glucose infusion, calculated to increase by 35% that in study 1. Results. In study 1, CON increased glucose uptake to 20 ± 3 μmol kg-1 min-1 after a biphasic insulin response. In study 2, CON further increased the glucose uptake via an increment in prehepatic insulin secretion that stimulated insulin sensitivity without changes in peripheral insulin and glucose concentrations. HEMI and PTX had 35% less glucose uptake in study I, compared to CON, and increased glucose concentrations (+ 1.6 mmol L-1) in study 2. We had an intermediate defect. The causes of intolerance were different: HEMI had a defective first-phase insulin secretion (50% peripheral insulin concentrations) but maintained insulin sensitivity; PTX had normal peripheral insulin but only one-third of the insulin sensitivity of CON. Conclusions. Hemipancreatectomy and systemic insulin delivery impair first-phase insulin secretion; second-phase peripheral insulinization (HEMI); insulin sensitivity (PTX); and a mechanism evidentiated in study 2 of CON that increases insulin sensitivity in response to prehepatic insulin secretion (both groups). Failure of these mechanisms is largely compensated by hyperglycaemia.

Original languageEnglish
Pages (from-to)397-410
Number of pages14
JournalEuropean Journal of Clinical Investigation
Volume30
Issue number5
DOIs
Publication statusPublished - 2000

Fingerprint

Insulin
Glucose
Insulin Resistance
Biphasic Insulins
Uveitis
Hyperglycemia
Immunosuppression
Pancreas
Transplants
Clamping devices
Control Groups
Defects

Keywords

  • Glucose tolerance
  • Hemipancreatectomy
  • Insulin secretion
  • Insulin sensitivity
  • Pancreas transplantation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Effect of hemipancreatectomy and of pancreatic diversion on the tolerance to a glucose load in humans. / Battezzati, A.; Zerbi, A.; Perseghin, G.; Caumo, A.; Terruzzi, I.; Di Carlo, V.; Luzi, Livio.

In: European Journal of Clinical Investigation, Vol. 30, No. 5, 2000, p. 397-410.

Research output: Contribution to journalArticle

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abstract = "Background. The role of the pattern, quantity and site of insulin secretion in the tolerance to a glucose challenge is not fully evaluated in humans because it is difficult to obtain appropriate clinical models. Design. To address this issue, we studied subjects with reduced pancreatic mass (hemipancreatectomized, HEMI), systemic insulin delivery (pancreas transplant recipients, PTX), and two control groups (healthy, CON; and with uveitis on the same immunosuppression as PTX, UVE), with an hyperglycaemic clamp (study 1, + 4.2 mmol L-1), using a repeat experiment (study 2) with a fixed glucose infusion, calculated to increase by 35{\%} that in study 1. Results. In study 1, CON increased glucose uptake to 20 ± 3 μmol kg-1 min-1 after a biphasic insulin response. In study 2, CON further increased the glucose uptake via an increment in prehepatic insulin secretion that stimulated insulin sensitivity without changes in peripheral insulin and glucose concentrations. HEMI and PTX had 35{\%} less glucose uptake in study I, compared to CON, and increased glucose concentrations (+ 1.6 mmol L-1) in study 2. We had an intermediate defect. The causes of intolerance were different: HEMI had a defective first-phase insulin secretion (50{\%} peripheral insulin concentrations) but maintained insulin sensitivity; PTX had normal peripheral insulin but only one-third of the insulin sensitivity of CON. Conclusions. Hemipancreatectomy and systemic insulin delivery impair first-phase insulin secretion; second-phase peripheral insulinization (HEMI); insulin sensitivity (PTX); and a mechanism evidentiated in study 2 of CON that increases insulin sensitivity in response to prehepatic insulin secretion (both groups). Failure of these mechanisms is largely compensated by hyperglycaemia.",
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T1 - Effect of hemipancreatectomy and of pancreatic diversion on the tolerance to a glucose load in humans

AU - Battezzati, A.

AU - Zerbi, A.

AU - Perseghin, G.

AU - Caumo, A.

AU - Terruzzi, I.

AU - Di Carlo, V.

AU - Luzi, Livio

PY - 2000

Y1 - 2000

N2 - Background. The role of the pattern, quantity and site of insulin secretion in the tolerance to a glucose challenge is not fully evaluated in humans because it is difficult to obtain appropriate clinical models. Design. To address this issue, we studied subjects with reduced pancreatic mass (hemipancreatectomized, HEMI), systemic insulin delivery (pancreas transplant recipients, PTX), and two control groups (healthy, CON; and with uveitis on the same immunosuppression as PTX, UVE), with an hyperglycaemic clamp (study 1, + 4.2 mmol L-1), using a repeat experiment (study 2) with a fixed glucose infusion, calculated to increase by 35% that in study 1. Results. In study 1, CON increased glucose uptake to 20 ± 3 μmol kg-1 min-1 after a biphasic insulin response. In study 2, CON further increased the glucose uptake via an increment in prehepatic insulin secretion that stimulated insulin sensitivity without changes in peripheral insulin and glucose concentrations. HEMI and PTX had 35% less glucose uptake in study I, compared to CON, and increased glucose concentrations (+ 1.6 mmol L-1) in study 2. We had an intermediate defect. The causes of intolerance were different: HEMI had a defective first-phase insulin secretion (50% peripheral insulin concentrations) but maintained insulin sensitivity; PTX had normal peripheral insulin but only one-third of the insulin sensitivity of CON. Conclusions. Hemipancreatectomy and systemic insulin delivery impair first-phase insulin secretion; second-phase peripheral insulinization (HEMI); insulin sensitivity (PTX); and a mechanism evidentiated in study 2 of CON that increases insulin sensitivity in response to prehepatic insulin secretion (both groups). Failure of these mechanisms is largely compensated by hyperglycaemia.

AB - Background. The role of the pattern, quantity and site of insulin secretion in the tolerance to a glucose challenge is not fully evaluated in humans because it is difficult to obtain appropriate clinical models. Design. To address this issue, we studied subjects with reduced pancreatic mass (hemipancreatectomized, HEMI), systemic insulin delivery (pancreas transplant recipients, PTX), and two control groups (healthy, CON; and with uveitis on the same immunosuppression as PTX, UVE), with an hyperglycaemic clamp (study 1, + 4.2 mmol L-1), using a repeat experiment (study 2) with a fixed glucose infusion, calculated to increase by 35% that in study 1. Results. In study 1, CON increased glucose uptake to 20 ± 3 μmol kg-1 min-1 after a biphasic insulin response. In study 2, CON further increased the glucose uptake via an increment in prehepatic insulin secretion that stimulated insulin sensitivity without changes in peripheral insulin and glucose concentrations. HEMI and PTX had 35% less glucose uptake in study I, compared to CON, and increased glucose concentrations (+ 1.6 mmol L-1) in study 2. We had an intermediate defect. The causes of intolerance were different: HEMI had a defective first-phase insulin secretion (50% peripheral insulin concentrations) but maintained insulin sensitivity; PTX had normal peripheral insulin but only one-third of the insulin sensitivity of CON. Conclusions. Hemipancreatectomy and systemic insulin delivery impair first-phase insulin secretion; second-phase peripheral insulinization (HEMI); insulin sensitivity (PTX); and a mechanism evidentiated in study 2 of CON that increases insulin sensitivity in response to prehepatic insulin secretion (both groups). Failure of these mechanisms is largely compensated by hyperglycaemia.

KW - Glucose tolerance

KW - Hemipancreatectomy

KW - Insulin secretion

KW - Insulin sensitivity

KW - Pancreas transplantation

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