Abstract
To determine the effects of pancreas transplantation on counterregulation, we examined plasma glucose, glucagon, and epinephrine responses to insulin-induced hypoglycemia in six pancreas and kidney recipients (PK; 35±4 years, mean±SD) in comparison with the corresponding data from four diabetic patients after solitary kidney transplantation (K; 35±6), five diabetic patients receiving hemodialysis (H; 32±8), and 10 normal individuals (N; 30±2). We also performed cardiovascular reflex tests to evaluate the function of the autonomic nervous system. The incremental glucagon levels 40min after insulin injection were significantly greater in the PK (63±22pg/ml, mean±SE) than in the H (6±10) group, and also greater than those observed in the N (38±7) and K (15±7) groups. Although plasma epinephrine responses in the K and H groups were delayed, the responses of the PK group were similar to those of the N group. Glucose recovery from hypoglycemia, in the PK group, was greater than those in the K and H groups. Autonomic nervous system function in the PK group, judged by cardiovascular reflex tests, was superior to those in the K and H groups. The results suggest that pancreas transplantation markedly improves the disturbed counterregulatory responses in IDDM, and also suggest that the normalization of glycemic control and amelioration of autonomic neuropathy lead to improved responses.
