The ketosis-resistance in fibro-calculous-pancreatic-diabetes. 1. Clinical observations and endocrine-metabolic measurements during oral glucose tolerance test

Abstract

We measured circulating levels of C-peptide, pancreatic glucagon, cortisol, growth hormone and metabolites (glucose, non-esterified fatty acids, glcerol and 3-hydroxybutyrate) in fibro-calculous-pancreatic diabetic (FCPD, n = 28), insulin-dependent diabetic (IDDM, n = 28) and non-diabetic control ( n = 27) subjects during an oral glucose tolerance test. There was no difference in the two diabetic groups in age (FCPD 24 ± 2, IDDM 21 ± 2 years, mean ± SEM), BMI (FCPD 16.0 ± 0.6, IDDM 15.7 ± 0.4 kg/m 2), triceps skinfold thickness (FCPD 8 ± 1, IDDM 7 ± 1 mm), glycaemic status (fasting plasma glucose, FCPD 12.5 ± 1.5, IDDM 14.5 ± 1.2 mmol/l), fasting plasma C-peptide (FCPD 0.13 ± 0.03, IDDM 0.08 ± 0.01 nmol/l), peak plasma C-peptide during OGTT (FCPD 0.36 ± 0.10, IDDM 0.18 ± 0.03 nmol/l) and fasting plasma glucagon (FCPD 35 ± 4, IDDM 37 ± 4 ng/l). FCPD patients, however, showed lower circulating concentrations of non-esterified fatty acids (0.73 ± 0.11 mmol/l), glycerol (0.11 ± 0.02 mmol/l) and 3-hydroxybutyrate (0.15 ± 0.03 mmol/l) compared to IDDM patients (1.13 ± 0.14, 0.25 ± 0.05 and 0.29 ± 0.08 mmol/l, respectively). This could be due to enhanced sensitivity of adipose tissue lipolysis to the suppressive action of circulating insulin and possibly also to insensitivity of hepatic ketogenesis to glucagon. Our results also demonstrate preservation of α-cell function in FCPD patients when β-cell function is severely diminished, suggesting a more selective β-cell dysfunction or destruction than hitherto believed.