Abstract
A new surgical method of treating patients with unstable insulin-dependent diabetes (IDD) has been developed-that of surgically shunting pancreatic blood into the systemic blood flow with the purpose of creating a more optimal interaction of subcutaneously administered insulin and pancreas-secreted glucagon. The long term results of the operation depend on the patency of a splenorenal anastomosis. This has been studied by following up 137 patients over periods from half a year to three years. Anastomotic patency was determined by renal and splenic venography and celiacy arteriography, which revealed a patent anastomosis in 114 patients, and an obliterated one in 23. Patients with patent anastomoses showed a lowering of glycosylated hemoglobin (HbAlc) from 13.3±0.03% to 9.3±0.6%, p<0.05, a decrease of the injected insulin dose from 0.97±0.04 to 0.72±0.03 U/ kg, p<0.05, disappearance or considerable abatement of pain in the lower extremities, and of hypoglycemia. Improvement of clinical status was accompanied by an increase of glucagon in the systemic blood stream from 60.8±10.1 to 91.5±9.4 pg/ml, p<0.05, a rise of tissue oxygen pressure, PO2, from 49.2±2.4 to 58.1±1.9 mm Hg, p<0.05. In patients with oblivious anastomoses postoperative HbAlc levels did not change from preoperative values: 12.9±0.4% and 12.8±0.7%, p<0.05, respectively; the insulin dose remained the same-0.91 ±0.07 U/kg and 0.85±0.07 U/kg, p<0.05, no rise of the systemic blood glucagon content was noted, and former complaints continued. The suggested method is not an alternative for insulin therapy, but considerably enhances its potential.
Highlights
It is common knowledge that the basis of the pathogenesis of insulin-dependent diabetes (IDD) is insufficiency of insulin
After surgery the glucagon level in the systemic blood flow increased in all the patients, and this was accompanied by a drop of the cortisol content in 8 persons
The liver is the chief organ for the metabolism of pancreatic hormones, determining glucose homeostasis
Summary
It is common knowledge that the basis of the pathogenesis of insulin-dependent diabetes (IDD) is insufficiency of insulin. Exogenous insulin is injected into IDD patients subcutaneously, with only part of it reaching the liver where-as all the endogenously secreted glucagon enters the liver via the splenic and portal veins. Stabilization of the course of diabetes and the development Angiographic Techniques of angiopathy, accompanied by the disappearance or abatement of complaints of fatigue and pain in the lower extremities, occurred in 75 percent of cases The purpose of this investigation was to determine how remote results of surgery depend on the patency of the splenorenal anastomosis. In 14 patients preelse, apart from the randomized group, patients were senting with patent anastomoses, both renal venotaken at various postoperative periods: 74 at 6 graphy and arteriography were performed in order to months, 54 at a year, 8 at two years, and 4 at three verify the anurons of radiograph interpretations in years after the operation This corresponded to the patients with patent and obstructed anastomoses. Kidney function was assessed by the rate of glomerular filtration, determined by 24-hour endogenous creatinine clearance
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