Bogachus Lindsey D, Oseid Elizabeth, Bellin Melena, Vella Adrian, Robertson R Paul
Pacific Northwest Diabetes Research Institute, Seattle, Washington 98122.
Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, Washington 98195.
J Clin Endocrinol Metab. 2017 Sep 1;102(9):3288-3295. doi: 10.1210/jc.2017-00923.
Total pancreatectomy followed by intrahepatic islet autotransplantation (TP/IAT) is performed to alleviate severe, unrelenting abdominal pain caused by chronic pancreatitis, to improve quality of life, and to prevent diabetes.
To determine the cause of exercise-induced hypoglycemia that is a common complaint in TP/IAT recipients.
Participants completed 1 hour of steady-state exercise.
Hospital research unit.
We studied 14 TP/IAT recipients and 10 age- and body mass index-matched control subjects.
Peak oxygen uptake (VO2) was determined via a symptom-limited maximal cycle ergometer test. Fasted subjects then returned for a primed [6,6-2H2]-glucose infusion to measure endogenous glucose production while completing 1 hour of bicycle exercise at either 40% or 70% peak VO2.
Blood samples were obtained to measure glucose metabolism and counterregulatory hormones before, during, and after exercise.
Although the Borg Rating of Perceived Exertion did not differ between recipients and control subjects, aerobic capacity was significantly higher in controls than in recipients (40.4 ± 2.0 vs 27.2 ± 1.4 mL/kg per minute; P < 0.001). This difference resulted in workload differences between control subjects and recipients to reach steady-state exercise at 40% peak VO2 (P = 0.003). Control subjects significantly increased their endogenous glucose production from 12.0 ± 1.0 to 15.2 ± 1.0 µmol/kg per minute during moderate exercise (P = 0.01). Recipients did not increase endogenous glucose production during moderate exercise (40% peak VO2) but succeeded during heavy exercise, from 10.1 ± 0.4 to 14.8 ± 2.0 µmol/kg per minute (70% peak VO2; P = 0.001).
Failure to increase endogenous glucose production during moderate exercise may be a key contributor to the hypoglycemia TP/IAT recipients experience.
全胰切除术后行肝内胰岛自体移植（TP/IAT）旨在缓解慢性胰腺炎所致的严重、持续性腹痛，改善生活质量，并预防糖尿病。
确定运动诱发低血糖的原因，这是TP/IAT受者常见的主诉。
参与者完成1小时的稳态运动。
医院研究单位。
我们研究了14名TP/IAT受者和10名年龄及体重指数匹配的对照受试者。
通过症状限制的最大运动试验测定峰值摄氧量（VO2）。空腹受试者随后返回接受[6,6-2H2]葡萄糖预充输注，以测量内源性葡萄糖生成，同时在峰值VO2的40%或70%下完成1小时的自行车运动。
在运动前、运动中和运动后采集血样，以测量葡萄糖代谢和对抗调节激素。
尽管受者和对照受试者之间的博格自觉用力评分没有差异，但对照组的有氧能力显著高于受者（40.4±2.0对27.2±1.4毫升/千克每分钟；P<0.001）。这种差异导致对照组和受者在达到峰值VO2的40%进行稳态运动时的工作量不同（P=0.003）。对照组在中等强度运动期间内源性葡萄糖生成从12.0±1.0显著增加至15.2±1.0微摩尔/千克每分钟（P=0.01）。受者在中等强度运动（峰值VO2的40%）期间内源性葡萄糖生成未增加，但在剧烈运动期间成功增加，从10.1±0.4增加至14.8±2.0微摩尔/千克每分钟（峰值VO2的70%；P=0.001）。
中等强度运动期间内源性葡萄糖生成未能增加可能是TP/IAT受者发生低血糖的关键因素。
