A. Lienhardt et al., INSULIN-SECRETION AND SENSITIVITY IN CHILDREN ON CYCLIC TOTAL PARENTERAL-NUTRITION, JPEN. Journal of parenteral and enteral nutrition, 22(6), 1998, pp. 382-386
Background: Some children receiving total parenteral nutrition (TPN) h
ave abnormal glucose tolerance. Methods: Insulin secretion and sensiti
vity were studied in 12 patients, aged 5.7 to 19.4 years, receiving cy
clic nocturnal TPN. Insulin secretion was measured during an IV glucos
e tolerance test (IVGTT; 0.5 g/kg) followed by a hyperglycemic clamp (
plasma glucose at 10 mmol/L). Insulin sensitivity was assessed by hype
rinsulinemic euglycemic clamp (insulin infusion = 1 mU/kg/min). Result
s;: Patients with normal glucose tolerance receiving TPN had an insuli
n response to IVGTT similar to that of normal children of the same age
. Insulin levels of TPN patients were higher than those in healthy you
ng adults during the hyperglycemic clamp. Whole body glucose disposal
was greater in younger than in older children (range, 7.1 to 25.2 mg/k
g/min), and this inverse correlation with age was statistatically sign
ificant (p <.01). Two patients with abnormal glucose tolerance showed
a decreased capacity to release insulin, whereas insulin sensitivity w
as unchanged in one of these two patients. Two patients treated with p
rednisone or octreotide had insulin levels similar to those of normal
TPN children. Conclusions: The insulin response to sustained hyperglyc
emia was stronger in children with normal glucose tolerance on cyclic
TPN. Patients with a limited capacity to release insulin, either const
itutional or acquired, may not be able to produce enough insulin in th
ese conditions and develop glucose intolerance during TPN. Insulin sen
sitivity was not a key factor in the alteration of glucose tolerance.