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INSULIN RESPONSE TO GLUCAGON IN OBESE CHILDREN
1188 left-sided lesions, it was usually associated with intestinal obstruction, but was infrequently so in right-sided lesions. Abdominal mass was a presenting complaint in with right-sided lesions. Department of Surgery,
University Hospital, Mona, Kingston 7, Jamaica.
40% of our patients
E. R. WALROND.
INSULIN RESPONSE TO GLUCAGON IN OBESE CHILDREN with SIR,-Many patients maturity-onset diabetes and many obese adults have a metabolic abnormality characterised by increased blood-insulin levels and impaired glucose tolerance.I-7 Although such a relationship does not occur in childhood, when diabetes is characterised by a lack of insulin, there is increasing evidence that in both age-groups obesity is usually accompanied by hyperinsulinism, either in fasting conditions or after stimulation by administration of glucose or tolbutamide."-9 Glucagon promotes insulin secretion 10 11 and this action is much more pronounced in obese adults than in normals.12 Increased blood-levels of glucagon have been reported in obese children,13 but there is so far no published information about the insulin-releasing effect of glucagon in obesity during childhood, although such studies have been done in other diseases in infancy such as Down’s syndrome 14 and juvenile diabetes." We have carried out a preliminary study, the results of which are summarised in the accompanying table. Glucagon, 1 mg. per sq.m. body-surface, was administered intravenously after a 12-hour fast to 7 obese children aged 4-10 years and 7 controls of comparable age; plasma-insulin was 1. 2.
3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.
R. R.
S., Berson, G. A. Diabetes, 1960, 9, 254. S., Glick, G. M., Roth, H., Berson, G. A. Ann. N.Y. Acad. Sci. 1965, 131, 357. Karam, J. H., Grodsky, G. M., Forsham, P. H. Diabetes, 1963, 12, 197. Rabinowitz, D., Zierler, K. L. Lancet, 1960, ii, 690. Rabinowitz, D., Zierler, K. L. J. clin. Invest. 1962, 41, 2173. Melani, F. in Intravenous Tolbutamide Test (edited by W. Crezfeldt and A. Czyzyk); p. 106. I Capri Conference, March 22-23, 1967. Vague, P., Boeuf, G., Rouvier-Leroy, C. ibid. p. 193. Paulsen, E. P., Richenderfer, L., Ginsberg-Wellner, F. Diabetes, 1968, 17, 261. Cutillo, S., Iafusco, F., Stoppoloni, G., Sgambato, S. Pediatria, Napoli, 1968, 76, 178. Samols, E., Marri, G., Marks, V. Diabetes, 1966, 15, 855. Ketterer, H., Eisentraut, A. M., Unger, R. H. ibid. 1967, 16, 283. Benedetti, A., Simpson, R. G., Grodsky, G. M., Forsham, P. H. ibid. p. 666. Paulsen, E. P., Lawrence, A. M. Lancet, July 13, 1968, p. 110. Milunski, A., Marks, V., Samols, E. ibid. 1967, ii, 1093. Chiumello, G., Del Guercio, M. J., Bidone, G. Diabetes, 1968, 17, 133. Yalow, Yalow,
PLASMA-INSULIN AND BLOOD-GLUCOSE LEVELS AFTER
.
Not
assayed by the method of Hales and Randle 16 and glucose by the method of Somogyi.17 Blood-levels were determined at zero, and 5, 10, 20, 30, and 60 minutes after glucagon injection. A significantly greater increase in plasma-insulin levels was observed in the obese subjects than in the normals from 10 minutes onwards. At 60 minutes the plasma-insulin of non-obese children was back to starting values, while obese subjects still showed hyperinsulinaEmia. Initial insulin levels were higher in the obese subjects, but not significantly so. Despite differing plasma-insulin levels, the changes in bloodglucose were similar in the two groups. These findings are consistent with the observations of Benedetti et al.12 on obese adults. These workers showed that the increased insulin response to glucagon in obese patients was not accompanied by an increased rate of glucose utilisation. Our results seem therefore to give further support to the concept that obesity in childhood may be associated with the metabolic alterations often found in adult obesity, in contrast to the differences between maturity-onset and juvenile diabetes. S. CUTILLO V. ANSANELLI G. STOPPOLONI V. PACELLI. Department of Paediatrics, F. D’ONOFRIO. Department of Medicine, University of Naples, Italy. EMOTIONAL PROBLEMS IN A CHRONIC HÆMODIALYSIS UNIT SIR,-Iagree with Dr. De-Nour and Dr. Czaczkes (Nov. 9, p. 987) that many of the " constellation of stresses and reactions " among the medical staff of a regular dialysis unit are not uncommon in similar units elsewhere; but it would be surprising if this were not so. Indeed, it seems remarkable that a two-year inquiry was needed to describe experiences which have long been familiar to clinicians responsible for the long-term care of patients with potentially fatal diseases. It is the recognition of stresses and reactions of this kind that make it so necessary that a clinician should possess not only ability but also a clear insight into his own limitations. The increasing possibilities of prolonging life by artificial means has certainly resulted in an increasing burden of doubt as to when continued treatment is of worthwhile benefit to the patient, but this is a burden which doctors have always had to bear and which by their vocation they have elected to undertake.
GLUCAGON
significant.
16. 17.
Hales, C. N., Randle, H. J. Biochem. J. 1963, 80, 137. Somogyi, M. J. biol. Chem. 1952, 195, 19.
INJECTION
.. Not done.
IN OBESE CHILDREN AND NORMAL CONTROLS
University Hospital, Mona, Kingston 7, Jamaica.
40% of our patients
E. R. WALROND.
INSULIN RESPONSE TO GLUCAGON IN OBESE CHILDREN with SIR,-Many patients maturity-onset diabetes and many obese adults have a metabolic abnormality characterised by increased blood-insulin levels and impaired glucose tolerance.I-7 Although such a relationship does not occur in childhood, when diabetes is characterised by a lack of insulin, there is increasing evidence that in both age-groups obesity is usually accompanied by hyperinsulinism, either in fasting conditions or after stimulation by administration of glucose or tolbutamide."-9 Glucagon promotes insulin secretion 10 11 and this action is much more pronounced in obese adults than in normals.12 Increased blood-levels of glucagon have been reported in obese children,13 but there is so far no published information about the insulin-releasing effect of glucagon in obesity during childhood, although such studies have been done in other diseases in infancy such as Down’s syndrome 14 and juvenile diabetes." We have carried out a preliminary study, the results of which are summarised in the accompanying table. Glucagon, 1 mg. per sq.m. body-surface, was administered intravenously after a 12-hour fast to 7 obese children aged 4-10 years and 7 controls of comparable age; plasma-insulin was 1. 2.
3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.
R. R.
S., Berson, G. A. Diabetes, 1960, 9, 254. S., Glick, G. M., Roth, H., Berson, G. A. Ann. N.Y. Acad. Sci. 1965, 131, 357. Karam, J. H., Grodsky, G. M., Forsham, P. H. Diabetes, 1963, 12, 197. Rabinowitz, D., Zierler, K. L. Lancet, 1960, ii, 690. Rabinowitz, D., Zierler, K. L. J. clin. Invest. 1962, 41, 2173. Melani, F. in Intravenous Tolbutamide Test (edited by W. Crezfeldt and A. Czyzyk); p. 106. I Capri Conference, March 22-23, 1967. Vague, P., Boeuf, G., Rouvier-Leroy, C. ibid. p. 193. Paulsen, E. P., Richenderfer, L., Ginsberg-Wellner, F. Diabetes, 1968, 17, 261. Cutillo, S., Iafusco, F., Stoppoloni, G., Sgambato, S. Pediatria, Napoli, 1968, 76, 178. Samols, E., Marri, G., Marks, V. Diabetes, 1966, 15, 855. Ketterer, H., Eisentraut, A. M., Unger, R. H. ibid. 1967, 16, 283. Benedetti, A., Simpson, R. G., Grodsky, G. M., Forsham, P. H. ibid. p. 666. Paulsen, E. P., Lawrence, A. M. Lancet, July 13, 1968, p. 110. Milunski, A., Marks, V., Samols, E. ibid. 1967, ii, 1093. Chiumello, G., Del Guercio, M. J., Bidone, G. Diabetes, 1968, 17, 133. Yalow, Yalow,
PLASMA-INSULIN AND BLOOD-GLUCOSE LEVELS AFTER
.
Not
assayed by the method of Hales and Randle 16 and glucose by the method of Somogyi.17 Blood-levels were determined at zero, and 5, 10, 20, 30, and 60 minutes after glucagon injection. A significantly greater increase in plasma-insulin levels was observed in the obese subjects than in the normals from 10 minutes onwards. At 60 minutes the plasma-insulin of non-obese children was back to starting values, while obese subjects still showed hyperinsulinaEmia. Initial insulin levels were higher in the obese subjects, but not significantly so. Despite differing plasma-insulin levels, the changes in bloodglucose were similar in the two groups. These findings are consistent with the observations of Benedetti et al.12 on obese adults. These workers showed that the increased insulin response to glucagon in obese patients was not accompanied by an increased rate of glucose utilisation. Our results seem therefore to give further support to the concept that obesity in childhood may be associated with the metabolic alterations often found in adult obesity, in contrast to the differences between maturity-onset and juvenile diabetes. S. CUTILLO V. ANSANELLI G. STOPPOLONI V. PACELLI. Department of Paediatrics, F. D’ONOFRIO. Department of Medicine, University of Naples, Italy. EMOTIONAL PROBLEMS IN A CHRONIC HÆMODIALYSIS UNIT SIR,-Iagree with Dr. De-Nour and Dr. Czaczkes (Nov. 9, p. 987) that many of the " constellation of stresses and reactions " among the medical staff of a regular dialysis unit are not uncommon in similar units elsewhere; but it would be surprising if this were not so. Indeed, it seems remarkable that a two-year inquiry was needed to describe experiences which have long been familiar to clinicians responsible for the long-term care of patients with potentially fatal diseases. It is the recognition of stresses and reactions of this kind that make it so necessary that a clinician should possess not only ability but also a clear insight into his own limitations. The increasing possibilities of prolonging life by artificial means has certainly resulted in an increasing burden of doubt as to when continued treatment is of worthwhile benefit to the patient, but this is a burden which doctors have always had to bear and which by their vocation they have elected to undertake.
GLUCAGON
significant.
16. 17.
Hales, C. N., Randle, H. J. Biochem. J. 1963, 80, 137. Somogyi, M. J. biol. Chem. 1952, 195, 19.
INJECTION
.. Not done.
IN OBESE CHILDREN AND NORMAL CONTROLS