Glucagon Response to Glucose Challenge in Patients with Idiopathic Postprandial Syndrome

Abstract

Background: Postprandial syndrome is characterized by hunger, weakness and anxiety neurosis occurring after meals. Although abnormal glucagon response has been suggested, inaccuracies of the conventional glucagon measurement method have prevented from precise analysis. Recently, a more reliable dual-antibody sandwich enzyme-linked immunosorbent assay for glucagon has been developed. Methods:We conducted a 75 g oral glucose tolerance test (OGTT) extending to 4 hours in 14 patients with idiopathic postprandial syndrome. In addition to blood glucose and insulin, we have measured glucagon concentrations using the novel method and analyzed retrospectively.Results: Median (lower quartile, upper quartile) of age and BMI were 40 years old (30, 49) and 24.9 (23.1, 26.2), respectively. The OGTT revealed that one patient had a diabetic pattern, and two were glucose intolerant. Fasting insulin was 7.6 U/mL (6.8, 8.8) and reached 73.7 (54.3, 82.6) at 30 min. Insulin remained elevated until 180 min. The fasting glucagon was 21.1 pg/mL (16.1, 33.8), falling at 60 min to a nadir of 6.9 (3.5, 10.3), onethird of the baseline, then remaining suppressed until 180 min. Furthermore, we have found that two types of glucagon dynamics: one is lower fasting glucagon with further suppression and the other is normal or higher fasting glucagon with subsequent big drop.Conclusions: These data suggest that glucagon suppression is stronger in patients with idiopathic postprandial syndrome than in normal subjects previously reported. The present data will contribute to further understanding and future research of this syndrome.

The relationship between glucose and the liver-alpha cell axis – A systematic review

“…The first was characterized by lower fasting glucagon and further suppression during OGTT, and the second with fasting hyperglucagonemia and drastic decrease during OGTT. The authors concluded that glucagon suppression in patients with IPS is more substantial than in healthy individuals ( 59 ).…”

“…One article investigated both glucagon and AAs (20). In contrast, 12 other articles examined the effect of glucose administration on glucagon (7,(53)(54)(55)(56)(57)(58)(59)(60)(61)(62), and six other articles studied the effect of an OGTT on AAs (63)(64)(65)(66)(67)(68). The articles by Knop (7), Junker (54) and Wang et al (55) were the only trials to include i.v.…”

“…glucose infusions. Junker (54) mentioned 50g of glucose for OGTT, while the other authors administered 75g glucose OGTT (or 1.75g/kg body weight respectively) (7,20,53,54,(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68). Six articles included pediatric subjects (22,62,(68)(69)(70)(71)(72).…”

“…Literature research revealed thirteen articles (see Table 1) that investigated the effects of administration of glucose on glucagon (7,20,(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)71).…”