INSULIN PLUS GLUCAGON THERAPY IN THE MANAGEMENT OF POSTPANCREATECTOMYPATIENTS

In order to clarify the metabolic kinetics after total pancreatectomy, a study was performed mainly using indirect calorimetry in five patie nts under insulin control who had undergone total pancreatectomy. The effects of glucagon administration on metabolic kinetics was studied a nd the following results were obtained. 1) In cases of total pancreate ctomy under only insulin control, a reduction in the level of calorige nesis from proteins, mainly due to an impairment in the utilization of glycogenic amino acids, was seen. This result indicated that carbohyd rate was not utilized in the metabolism, and lipid metabolism kinetics based on the exacerbation of lipid catabolism was observed. 2) When a pharmacologically active amount of glucagon was administered to total pancreatectomy cases under insulin control, the oxidantion of glycoge nic amino acids and lipids increased and energy metabolic kinetics bec ame more efficient. Administration of glucagon was useful in the preve ntion of onset of a fatty liver following total pancreatectomy. 3) Whe n insulin was administered concomitantly with the pharmacologically ac tive amount of glucagon to total pancreatectomy cases under insulin co ntrol, with the I/G ratio in the blood similar to the physiological va lue, inhibition of protein catabolism and increased utilization of gly cogenic amino acids and branched-chain amino acids were observed. At t he same time, a marked improvement was seen in the utilization of carb ohydrate which had been suppressed, the utilization of lipid as a calo rigenesis was not suppressed, lipid catabolism was reduced and good me tabolic kinetics were seen. The above results indicated that it is imp ortant to administer not only insulin, but also glucagon concomitantly so that the blood I/G ratio becomes similar to the physiological valu e and the metabolic kinetics following total pancreatectomy come close r to physiological normality.