Summary
Plasma glucose, immunoreactive insulin and C-peptide concentrations were compared in nine pancreas-kidney-transplanted patients (systemic venous drainage) and in ten non-diabetic kidney-transplanted patients with similar kidney function. In the basal state, C-peptide (insulin secretion) was similar, but immunoreactive insulin was higher and glucose concentrations were slightly, but significantly lower in pancreas-transplanted patients. After 50 g oral glucose, the plasma glucose and IR-insulin profiles were similar in both groups. The circumvention of first-pass hepatic insulin extraction (decreased endogenous insulin clearance) was compensated for by a significant reduction in insulin secretion (C-peptide; p=0.036). In conclusion, hyperinsulinaemia in pancreas-transplanted patients with systemic venous drainage is significant only in the basal state. Insulin delivered into the portal and peripheral circulation, when leading to similar insulin profiles, maintains comparable degrees of glucose tolerance.
Article PDF
Similar content being viewed by others
References
Botz CK, Leibel BS, Zingg W, Gander RE, Albisser AM (1976) Comparison of peripheral and portal routes of insulin infusion by a computer-controlled insulin infusion system (artificial endocrine pancreas). Diabetes 25: 691–700
Bratusch-Marrain PR, Waldhäusl WK (1985) Suppression of basal, but not of glucose-stimulated insulin secretion by human insulin in healthy and obese hyperinsulinaemic subjects. Metabolism 34: 188–193
Calne RY (1984) Paratopic segmental pancreas grafting: a technique with portal venous drainage. The Lancet I: 595–597
DeFronzo RA, Binder C, Wahren J, Felig Ph, Ferrannini E, Faber OK (1981) Sensitivity of insulin secretion to feedback inhibition by hyperinsulinaemia. Acta Endocrinol 98: 81–86
Diem P, Abid M, Redmon JB, Sutherland DER, Robertson RP (1990) Systemic venous drainage of pancreas allografts as independent cause of hyperinsulinaemia in Type 1 diabetic recipients. Diabetes 39: 534–540
Ferrannini E, Cobelli C (1987) The kinetics of insulin in man. II. The role of the liver. Diabetes/Metabol Rev 3: 365–397
Helmchen U, Schmidt WE, Siegel EG, Creutzfeldt W (1984) Morphological and functional changes of pancreatic B cells in cyclosporin A-treated rats. Diabetologia 27: 416–419
Henriksen JH, Tronier B, Bülow JB (1987) Kinetics of circulating endogenous insulin, C-peptide and proinsulin in fasting non-diabetic man. Metabolism 36: 463–468
Ito C, Mito K, Hara H (1983) Review of the criteria for diagnosis of diabetes mellitus based on results of a follow-up study. Diabetes 28: 1039–1043
Jarrett RJ (1988) Is insulin atherogenic? (editorial). Diabetologia 31: 71–75
Kruszynska YT, Home PD, Alberti KGMM (1985) Comparison of portal and peripheral insulin delivery on carbohydrate metabolism in streptozotocin-diabetic rats. Diabetologia 28: 167–171
Luzi L, Battezzati A, Perseghin G, Facchini F, Vergani S, Di Carlo V, Pozza G (1991) Feedback inhibition of insulin (I) secretion in denervated pancreas. 10th workshop of the AIDSPIT study group (abstract)
Madsbad S, Christiansen E, Andersen HB, Christensen NJ, Rasmussen K, Olgaard K, Kirkegaard P, Volund Aa, Tronier B, Burcharth F (1990) B-cell defects after pancreas transplantation in Type 1 patients. Diabetes 39 (Suppl. 1): 15 A (abstract)
Osei K, Henry ML, O'Dorisio TM, Tesi RJ, Sommer BG, Ferguson RM (1990) Physiological and pharmacological stimulation of pancreatic islet hormone secretion in Type 1 diabetic pancreas allograft recipients. Diabetes 39: 1235–1242
Pagano G, Cavallo-Perin P, Cassader M, Bruno A, Ozzello A, Masciola P, Dall'Omo AM, Imbimbo B (1983) An in vivo and in vitro study of the mechanism of prednisone-induced insulin resistance in healthy subjects. J Clin Invest 72: 1814–1820
Polonsky K, Jaspan J, Woodle L, Thistlewaite R (1990) Alterations in the pattern of insulin secretion and C-peptide kinetics post pancreas transplantation. Diabetes 39 (Suppl. 1): 15 A (abstract)
Reaven GM, Olefsky J, Farquhar JW (1972) Does hyperglycaemia or hyperinsulinaemia characterize the patient with chemical diabetes? Lancet I: 1247–1249
Regeur L, Faber OK, Binder C (1978) Plasma C-peptide in uraemic patients. Scand J Clin Lab Invest 38: 771–775
Robertson RP, Franklin G, Nelson L (1989) Intravenous glucose tolerance and pancreatic islet beta-cell function in patients with multiple sclerosis during 2-yr treatment with cyclosporin. Diabetes 38: 58–64
Stagner J, Samols E, Polonsky K, Pugh W (1986) Lack of direct inhibition of insulin secretion by exogenous insulin in the canine pancreas. J Clin Invest 78: 1193–1198
Stöckmann F, Fehmann HC, Göke B, Siegel EG, Creutzfeldt W (1989) Impairment of stimulated insulin release from the isolated perfused rat pancreas by cyclosporin pretreatment. Transplantation 48: 381–385
Sutherland DER, Goetz FC, Moudry KC, Abouna GM, Najarian JS (1987) Use of recipient mesenteric vessels for revascularization of segmental pancreas grafts; technical and metabolical considerations. Transplant Proc 9: 2300–2304
Thompson DG, Wingate DL, Thomas M, Harrison D (1982) Gastric emptying as a determinant of the oral glucose tolerance test. Gastroenterol 82: 51–55
Zavaroni I, Deferrari G, Lugari R, Bonora E, Garibotto G, Dall'Aglio E, Robaudo E, Gnudi A (1987) Renal metabolism of C-peptide in man. J Clin Endocrinol Metab 65: 494–498
Zavaroni I, Bonora E, Pagliara M, Dall'Aglio E, Luchetti L, Buonanno G, Bonati PA, Bergonzani M, Gnudi L, Passeri M, Reaven G (1989) Risk factors for coronary artery disease in healthy persons with hyperinsulinaemia and normal glucose tolerance. N Engl J Med 320: 702–706
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nauck, M., Büsing, M., Siegel, E.G. et al. Consequences of systemic venous drainage and denervation of heterotopic pancreatic transplants for insulin/C-peptide profiles in the basal state and after oral glucose. Diabetologia 34 (Suppl 1), S81–S85 (1991). https://doi.org/10.1007/BF00587626
Issue Date:
DOI: https://doi.org/10.1007/BF00587626