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Insulin secretion and sensitivity in children on cyclic total parenteral nutrition
A Lienhardt1, B Rakotoambinina, V Colomb
1Department of Pediatric and Adolescent Diabetes, INSERM U30, Hôpital Necker-Enfants Malades, Paris, France.
Insights
Children on total parenteral nutrition (TPN) with normal glucose tolerance show a stronger insulin response to hyperglycemia. Impaired insulin release, not sensitivity, may cause glucose intolerance in TPN patients.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Nutritional Science
Background:
- Abnormal glucose tolerance is observed in some children receiving total parenteral nutrition (TPN).
- Understanding the mechanisms behind glucose intolerance during TPN is crucial for pediatric patient care.
Purpose of the Study:
- To investigate insulin secretion and sensitivity in children receiving cyclic nocturnal TPN.
- To determine the factors contributing to glucose intolerance in pediatric patients on TPN.
Main Methods:
- Studied 12 pediatric patients (5.7–19.4 years) on cyclic nocturnal TPN.
- Assessed insulin secretion via IV glucose tolerance test (IVGTT) and hyperglycemic clamp.
- Evaluated insulin sensitivity using hyperinsulinemic euglycemic clamp.
Main Results:
- Children on TPN with normal glucose tolerance had age-appropriate insulin responses to IVGTT.
- Insulin levels during hyperglycemic clamp were higher in TPN patients than healthy young adults.
- Whole-body glucose disposal showed a significant inverse correlation with age (p < .01).
- Two patients with abnormal glucose tolerance had reduced insulin release capacity; insulin sensitivity was unchanged in one.
- Prednisone or octreotide treatment did not affect insulin levels compared to normal TPN children.
Conclusions:
- Children with normal glucose tolerance on TPN exhibit a robust insulin response to sustained hyperglycemia.
- Impaired insulin release capacity, whether inherent or acquired, can lead to glucose intolerance during TPN.
- Insulin sensitivity does not appear to be a primary factor in altered glucose tolerance in these patients.
Background:
Some children receiving total parenteral nutrition (TPN) have abnormal glucose tolerance.
Methods:
Insulin secretion and sensitivity were studied in 12 patients, aged 5.7 to 19.4 years, receiving cyclic nocturnal TPN. Insulin secretion was measured during an IV glucose tolerance test (IVGTT; 0.5 g/kg) followed by a hyperglycemic clamp (plasma glucose at 10 mmol/L). Insulin sensitivity was assessed by hyperinsulinemic euglycemic clamp (insulin infusion = 1 mU/kg/min).
Results:
Patients with normal glucose tolerance receiving TPN had an insulin response to IVGTT similar to that of normal children of the same age. Insulin levels of TPN patients were higher than those in healthy young adults during the hyperglycemic clamp. Whole body glucose disposal was greater in younger than in older children (range, 7.1 to 25.2 mg/kg/min), and this inverse correlation with age was statistically significant (p < .01). Two patients with abnormal glucose tolerance showed a decreased capacity to release insulin, whereas insulin sensitivity was unchanged in one of these two patients. Two patients treated with prednisone or octreotide had insulin levels similar to those of normal TPN children.
Conclusions:
The insulin response to sustained hyperglycemia was stronger in children with normal glucose tolerance on cyclic TPN. Patients with a limited capacity to release insulin, either constitutional or acquired, may not be able to produce enough insulin in these conditions and develop glucose intolerance during TPN. Insulin sensitivity was not a key factor in the alteration of glucose tolerance.