Response to insulin of the intact stomach in patients with duodenal ulcer

Abstract

SUMMARY Insulin tests were performed on 47 duodenal ulcer patients with intact stomachs. Only 20 had a positive response to the test judged positive by the criteria of Hollander in the first 45 minutes after the insulin. Twenty became positive between 45 and 60 minutes, and in five the response was not noted until the second hour. Surprisingly, two patients had apparently negative responses to the insulin. While caution is necessary in comparing responses of the intact stomach to those after vagotomy operations, the occurrence of the 'late positive' and negative patterns of response to insulin in the intact stomach may give rise to reservations about the interpretation of these types of response after vagotomy.

Comparison of the Gastric Acid Responses to Pentagastrin and Insulin Hypoglycemia in Male and Female Ulcer Patients

“…In the remaining patients the responses were significant both according to our criterion [6] and to the criteria of Hollander [12], In 80% of the male and female duodenal ulcer patients the response was 'early' (within 45 min) as defined by Ross and K ay [22], and in 95% the response occurred within the 1st hour. A similar high percentage of response within the 1st hour has been reported previously [10,18]. No decrease of the acid output below basal level was seen after the insulin injection which is in accordance with the findings of others [13,15,20].…”

“…In 11 healthy males the acid responses to pentagastrin and insulin were equal [11] whereas in 6 male duodenal ulcer patients the average acid response to pentagastrin exceeded that to insulin [21]. In another 2 recent studies on duodenal ulcer patients [10,20] the acid response to pentagastrin was higher than the acid response to insulin but the sexes were not given. In the present study the mean PAO30 to pentagastrin exceeded that to insulin in male duodenal, prepyloric and corporal gastric ulcer patients but the mean PAO30 did not differ statistically in female duodenal ulcer patients.…”

“…In clinical research this test should in our opinion be carried out preoperatively also to evaluate quantitatively the effect of vagotomy on vagally (insulin) induced secretion. A preoperative insulin test is also essential since there are reports of absent [2,10,13,17] or 'late' [22] appearing responses in unoperated patients [2,10], In the present study, insulin hypoglycemia stimulated acid secretion in all patients according to our criterion [6], In 2 male patients (one with duodenal and one with pre pyloric gastric ulcer) the difference between the PAO30 to insulin and the highest 30-min basal acid output was small, or only 0.6 and 0.9 mEq, respec tively. According to the criteria of Hollander [12], insulin hypoglycemia produced no acid response in these 2 patients.…”

“…A few studies have recently been published in which such comparisons have been made in healthy male subjects [11], and in duodenal ulcer patients [10,20,21]. The number of patients was small, however, or else the sexes were not stated.…”

Dose response relationships of insulin hypoglycaemia and gastric acid in man

“…These results will be reported separately. Gillespie, Gillespie, and Kay (1969) found no significant difference between arterial and venous blood sugar concentrations during insulin tests.…”