Ketoacidosis in pancreatectomized man

Area of Science:

• Endocrinology
• Metabolic Disorders
• Diabetes Research

Background:

• Diabetic ketoacidosis (DKA) is a serious complication of diabetes.
• The role of glucagon in DKA development has been debated.
• Previous hypotheses suggested glucagon is essential for DKA.

Purpose of the Study:

• To investigate the necessity of glucagon in the development of diabetic ketoacidosis.
• To determine if glucagon is essential or merely contributory to DKA.
• To clarify the hormonal interplay in insulin deficiency-induced metabolic decompensation.

Main Methods:

• Withholding insulin from patients with juvenile-type diabetes and pancreatectomized subjects.
• Monitoring plasma glucagon, blood ketone, and blood glucose concentrations.
• Controlled study involving fasting patients previously maintained on intravenous insulin.

Main Results:

• In diabetic patients, insulin withdrawal led to sharp increases in plasma glucagon, blood ketones (4.1+/-0.7 mmol/L), and blood glucose (12.5+/-1.8 mmol/L).
• In pancreatectomized patients lacking measurable glucagon, blood ketones rose by 1.8+/-0.8 mmol/L and blood glucose by 7.7+/-1.5 mmol/L.
• These findings indicate glucagon is not indispensable for DKA development.

Conclusions:

• Glucagon is not essential for the development of diabetic ketoacidosis.
• Glucagon may accelerate the onset of ketonemia and hyperglycemia in insulin deficiency.
• The study refutes the essentiality of glucagon in DKA pathogenesis but highlights its accelerating role.