La relación insulina/glucagon en la remisión diabética espontánea. / [Insulin/glucagon relationship in spontaneous diabetic remission]

ABSTRACT

We define diabetic remission as the disappearance of clinical symptoms with normalization of blood glucose for a period over 15 days after withdrawal of insulin therapy. We studied 21 insulin-dependent diabetic children in remission (10 boys and 11 girls) and 29 normal children matched in age and sex as controls. Two tests were performed, intravenous glucose (IVGT) and glucose post-tolbutamide (PTGT). Two remission groups were studied with IVGT. Glucose, insulin, somatotropin and glucagon were determined in one and glucose and C-peptide in the other. Insulin secretion after IVGT was very low in the remission group, not surpassing basal value when stimulated. Only two girls showed normal or high insulin values during the study, and one of them showed the common hypoinsulinism of the remission group in a second study. The kinetics of glucagon and somatotropin secretion in the remission group were normal with low values of glucagon. When the integrated area (0-120 min) of hormone secretion (insulin, somatotropin and glucagon) was determined, the remission group had lower insulin and glucagon values (p less than 0.05) and identical growth hormone as the normal group. The insulin/glucagon ratio in normals and in remission were similar. During IVGT the remission group studied for C-peptide showed lower C-peptide values than normal group, resembling insulin behavior. In both groups, the glucose disappearance rate ([quot ]K[quot ] value) was higher in normals than in remissions (p less than 0.001). During the PTGT the normal group showed a peak of insulin secretion after tolbutamide and glucose stimulation. In the remission group, glucose was higher and insulin secretion lower than in the normal group, without a peak of insulin, and growth hormone and glucagon secretion were also lower.(ABSTRACT TRUNCATED AT 250 WORDS)