Insulin induced hypoglycaemia: comparison of glucose and glycerol concentrations in plasma and microdialysate from subcutaneous adipose tissue
a Department of Pediatrics and the Pediatric Endocrine
Research Unit, Huddinge University Hospital, Huddinge, Sweden, b Department of
Pediatrics, St Göran's Hospital, Karolinska Institute, Stockholm,
Sweden
Correspondence to: Dr C Marcus, Pediatric Endocrine Research Unit, B62, Karolinska Institute, Huddinge University Hospital, S-141 86 Huddinge, Sweden email: claude.marcus{at}pediat.hs.sll.se
Accepted 24
August 1998
AIMS
To investigate the dynamics between plasma
and dialysate glucose during hypoglycaemia in children.
STUDY DESIGNSix children in prepuberty or early
puberty were investigated by multiple blood sampling and microdialysis
of subcutaneous adipose tissue during a standard arginine-insulin
tolerance test. Glucose and glycerol, as an index of lipolysis, were
measured in samples from both compartments. Plasma concentrations of
insulin and the main counterregulatory hormones were also measured.
RESULTSPlasma and dialysate glucose
concentrations were very similar at baseline and increased in concert
after infusion of arginine, probably in response to glucagon release.
After insulin injection, glucose in both plasma and dialysate fell in
parallel. The subsequent hypoglycaemic stress response induced a rapid
rebound in the plasma concentration with a mean (SD) delay in the
dialysate of 16 (3) minutes. Plasma glycerol was approximately fivefold
lower than in the dialysate and did not fluctuate significantly.
Dialysate glycerol decreased with arginine infusion and reached a nadir immediately following insulin administration. Subsequently, the antilipolytic effect of insulin was overcome by the hypoglycaemic stress response, and lipolysis prevailed in spite of hyperinsulinaemia.
CONCLUSIONAfter rapidly induced
hypoglycaemia, rebound of interstitial glucose concentrations is
significantly delayed compared with plasma concentrations, and the
antilipolytic effect of hyperinsulinaemia is opposed possibly by the
hypoglycaemic stress response.
© 1999 by Archives of Disease in Childhood
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