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      Effect of Glucagon on Glucose Production, Lipolysis, and Gluconeogenesis in Familial Hyperinsulinism

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          Abstract

          We present an infant with severe familial hyperinsulinism in whom glucose production rate, lipolysis, and gluconeogenesis from glycerol were measured by use of glucose and glycerol labelled with stable isotopes. Administration of a single dose of glucagon (0.1 mg/kg) caused an increase in glucose production rate by near 140% from 4.2 to 10.1 mg·kg<sup>–1</sup>·min<sup>–1</sup>. The rate of appearance of glycerol, reflecting the rate of lipolysis, decreased from 15.1 to 12.6 µmol· kg<sup>–1</sup>·min<sup>–1</sup>. The amount of glycerol converted to glucose by gluconeogenesis was 9.1 µmol·kg<sup>–1</sup>·min<sup>–1</sup> before and 10.5 µmol·kg<sup>–1</sup>·min<sup>–1</sup> after glucagon administration. We conclude that the marked rise in glucose production rate was mainly the result of increased glycogenolysis. Following the trial, the child was started on long-acting (zinc-protamine) glucagon which made it possible to discontinue intravenous treatment with glucose.

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          Familial hyperinsulinism maps to chromosome 11p14-15.1, 30 cM centromeric to the insulin gene.

          Familial hyperinsulinism (HI) is the most common cause of persistent neonatal hyperinsulinaemic hypoglycemia. Linkage analysis in 15 families (12 Ashkenazi Jewish, 2 consanguineous Arab, 1 non-Jewish Caucasian) mapped HI to chromosome 11p14-15.1 (lod score = 9.5, theta = 0 at D11S921). Recombinants localized the disease locus to the 6.6 cM interval between D11S926 and D11S928. In Jewish families, association (p = 0.003) with specific D11S921/D11S419 haplotypes suggested a founder effect. This locus, which is important for normal glucose-regulated insulin secretion, represents a candidate gene for studies of other diseases of beta-cell dysfunction including non-insulin-dependent diabetes mellitus (NIDDM).
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            Author and article information

            Journal
            HRE
            Horm Res Paediatr
            10.1159/issn.1663-2818
            Hormone Research in Paediatrics
            S. Karger AG
            1663-2818
            1663-2826
            1998
            August 1998
            17 August 1998
            : 50
            : 2
            : 94-98
            Affiliations
            Uppsala University Children’s Hospital, Uppsala, Sweden
            Article
            23242 Horm Res 1998;50:94–98
            10.1159/000023242
            9701703
            © 1998 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            Page count
            Pages: 5
            Categories
            Case Report

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