Altered insulin response to a balanced test meal in bulimic patients

Abstract

Impaired glucose tolerance with overshooting insulin secretion has been reported in anorexia nervosa, in starvation, and in low carbohydrate diets. Since impaired glucose tolerance is a further indicator of starvation andlor carbohydrate restriction and possibly contributes to impairment of mechanisms of hunger and satiety, we examined insulin and glucose responses in bulimic patients. Data show that in bulimic patients as compared with age‐matched controls, insulin secretion and glucose levels can be elevated after a balanced test meal. This indicates disturbed glucose tolerance. Whether this reduced glucose tolerance can be related to altered kinetics of insulin release or to cellular insulin resistance cannot be decided on the basis of our data.

Physiological and psychological responses to a glucose challenge in bulimia

“…Neither insulin or glucagon levels differed from controls. These findings are in marked contrast to those of Schweiger et al (1987), who reported that bulimics exhibit markedly elevated blood glucose and insulin levels following a test meal. Casper, Davis, & Pandey (1977) have reported excessively high glucose concentrations in 11 out of 12 patients with anorexia nervosa, whereas Mitchell & Bantle (1983), Hohlstein et al (1986), and Weingarten et al (1988) found no difference in peak glucose levels between normal-weight bulimics and controls in response to an oral GTT.…”

“…The extent to which elevations of blood glucose levels are observed among normal-weight bulimics may be affected by the proportion of patients in the sample with a past history of anorexia nervosa as well as the extent of fasting immediately prior to the GTT. Thirty percent of the Schweiger et al (1987) group reported a history of anorexia nervosa, whereas while only one (5%) of our sample and none of the Weingarten et al (1988) group reported such a history. Our results, therefore, more closely resemble those of Weingarten et al, (1988) who similarly failed to obtain elevated blood glucose among normal-weight bulimics.…”

Physiological and psychological responses to a glucose challenge in bulimia

“…Neither insulin or glucagon levels differed from controls. These findings are in marked contrast to those of Schweiger et al (1987), who reported that bulimics exhibit markedly elevated blood glucose and insulin levels following a test meal. Casper, Davis, & Pandey (1977) have reported excessively high glucose concentrations in 11 out of 12 patients with anorexia nervosa, whereas Mitchell & Bantle (1983), Hohlstein et al (1986), and Weingarten et al (1988) found no difference in peak glucose levels between normal-weight bulimics and controls in response to an oral GTT.…”

“…The extent to which elevations of blood glucose levels are observed among normal-weight bulimics may be affected by the proportion of patients in the sample with a past history of anorexia nervosa as well as the extent of fasting immediately prior to the GTT. Thirty percent of the Schweiger et al (1987) group reported a history of anorexia nervosa, whereas while only one (5%) of our sample and none of the Weingarten et al (1988) group reported such a history. Our results, therefore, more closely resemble those of Weingarten et al, (1988) who similarly failed to obtain elevated blood glucose among normal-weight bulimics.…”

Insulin, glucose, and cortisol levels in bulimia: Effect of treatment

“…One mechanism whereby binge eating might be facilitated is the potentiation of insulin secretion in response to carbohydrate ingestion following starvation as demonstrated in a single case study of a bulimic patient by Russell et al (1987). Schweiger et al (1987) showed increased insulin secretion in bulimic patients following a test meal which lends further support to this hypothesis. In animal models corticosterone levels are directly related to central noradrenergic activity where both are suppressed by glucose administration and increased plasma glucose (Smythe et al, 1983, Smythe et al, 1984.…”

“…It is postulated that intermittent starvation and its relief through binge eating instigates a self-perpetuating hyperinsulinemic reponse as a metabolic defense. Support for this hypothesis is provided by the findings in bulimic patients of Schweiger et al (1987) and the early work of Unger et al (1963) in experimental starvation and Crisp et al (1967) and Kalucy et al (1976) in patients with anorexia nervosa. Furthermore, stress reduction through carbohydrate ingestion in the chronically intermittently starved individual might be reflected in a greater reduction in cortisol than a situation of normal nutrition.…”

Preliminary examination of insulin and amylin levels in women with purging disorder

“…Results from prior studies of insulin in BN are mixed and largely suggest that insulin may not be a major influence on the pathophysiology of BN (Johnson, Jarrell, Chupurdia, & Williamson, ; Naessén et al, ; Russell, Hooper, & Hunt, ; Schweiger et al, ). Our results also found no significant difference in insulin release between BN and control participants but did suggest greater sensitivity to the effects of insulin in both BN and PD.…”

Physiological and psychological responses to a glucose challenge in bulimia

“…Neither insulin or glucagon levels differed from controls. These findings are in marked contrast to those of Schweiger et al (1987), who reported that bulimics exhibit markedly elevated blood glucose and insulin levels following a test meal. Casper, Davis, & Pandey (1977) have reported excessively high glucose concentrations in 11 out of 12 patients with anorexia nervosa, whereas Mitchell & Bantle (1983), Hohlstein et al (1986), and Weingarten et al (1988) found no difference in peak glucose levels between normal-weight bulimics and controls in response to an oral GTT.…”

“…The extent to which elevations of blood glucose levels are observed among normal-weight bulimics may be affected by the proportion of patients in the sample with a past history of anorexia nervosa as well as the extent of fasting immediately prior to the GTT. Thirty percent of the Schweiger et al (1987) group reported a history of anorexia nervosa, whereas while only one (5%) of our sample and none of the Weingarten et al (1988) group reported such a history. Our results, therefore, more closely resemble those of Weingarten et al, (1988) who similarly failed to obtain elevated blood glucose among normal-weight bulimics.…”

Insulin, glucose, and cortisol levels in bulimia: Effect of treatment

“…One mechanism whereby binge eating might be facilitated is the potentiation of insulin secretion in response to carbohydrate ingestion following starvation as demonstrated in a single case study of a bulimic patient by Russell et al (1987). Schweiger et al (1987) showed increased insulin secretion in bulimic patients following a test meal which lends further support to this hypothesis. In animal models corticosterone levels are directly related to central noradrenergic activity where both are suppressed by glucose administration and increased plasma glucose (Smythe et al, 1983, Smythe et al, 1984.…”

“…It is postulated that intermittent starvation and its relief through binge eating instigates a self-perpetuating hyperinsulinemic reponse as a metabolic defense. Support for this hypothesis is provided by the findings in bulimic patients of Schweiger et al (1987) and the early work of Unger et al (1963) in experimental starvation and Crisp et al (1967) and Kalucy et al (1976) in patients with anorexia nervosa. Furthermore, stress reduction through carbohydrate ingestion in the chronically intermittently starved individual might be reflected in a greater reduction in cortisol than a situation of normal nutrition.…”

Preliminary examination of insulin and amylin levels in women with purging disorder

“…Results from prior studies of insulin in BN are mixed and largely suggest that insulin may not be a major influence on the pathophysiology of BN (Johnson, Jarrell, Chupurdia, & Williamson, ; Naessén et al, ; Russell, Hooper, & Hunt, ; Schweiger et al, ). Our results also found no significant difference in insulin release between BN and control participants but did suggest greater sensitivity to the effects of insulin in both BN and PD.…”

Physiological and psychological responses to a glucose challenge in bulimia

“…Neither insulin or glucagon levels differed from controls. These findings are in marked contrast to those of Schweiger et al (1987), who reported that bulimics exhibit markedly elevated blood glucose and insulin levels following a test meal. Casper, Davis, & Pandey (1977) have reported excessively high glucose concentrations in 11 out of 12 patients with anorexia nervosa, whereas Mitchell & Bantle (1983), Hohlstein et al (1986), and Weingarten et al (1988) found no difference in peak glucose levels between normal-weight bulimics and controls in response to an oral GTT.…”

“…The extent to which elevations of blood glucose levels are observed among normal-weight bulimics may be affected by the proportion of patients in the sample with a past history of anorexia nervosa as well as the extent of fasting immediately prior to the GTT. Thirty percent of the Schweiger et al (1987) group reported a history of anorexia nervosa, whereas while only one (5%) of our sample and none of the Weingarten et al (1988) group reported such a history. Our results, therefore, more closely resemble those of Weingarten et al, (1988) who similarly failed to obtain elevated blood glucose among normal-weight bulimics.…”

Insulin, glucose, and cortisol levels in bulimia: Effect of treatment

“…One mechanism whereby binge eating might be facilitated is the potentiation of insulin secretion in response to carbohydrate ingestion following starvation as demonstrated in a single case study of a bulimic patient by Russell et al (1987). Schweiger et al (1987) showed increased insulin secretion in bulimic patients following a test meal which lends further support to this hypothesis. In animal models corticosterone levels are directly related to central noradrenergic activity where both are suppressed by glucose administration and increased plasma glucose (Smythe et al, 1983, Smythe et al, 1984.…”

“…It is postulated that intermittent starvation and its relief through binge eating instigates a self-perpetuating hyperinsulinemic reponse as a metabolic defense. Support for this hypothesis is provided by the findings in bulimic patients of Schweiger et al (1987) and the early work of Unger et al (1963) in experimental starvation and Crisp et al (1967) and Kalucy et al (1976) in patients with anorexia nervosa. Furthermore, stress reduction through carbohydrate ingestion in the chronically intermittently starved individual might be reflected in a greater reduction in cortisol than a situation of normal nutrition.…”

Preliminary examination of insulin and amylin levels in women with purging disorder

“…Results from prior studies of insulin in BN are mixed and largely suggest that insulin may not be a major influence on the pathophysiology of BN (Johnson, Jarrell, Chupurdia, & Williamson, ; Naessén et al, ; Russell, Hooper, & Hunt, ; Schweiger et al, ). Our results also found no significant difference in insulin release between BN and control participants but did suggest greater sensitivity to the effects of insulin in both BN and PD.…”