ABNORMAL GLUCAGON RESPONSE IN CHILDREN WITH DUMPING SYNDROME

Abnormalities in glucose counterregulation may play a role in the pathophysiology delayed hypoglycemia in dumping syndrome (DS). In normal subjects, plasma glucagon increases by at least 50-100% in response to hypoglycemia. The aim of this study was to evaluate the glucagon response to hypoglycemia in children with DS. Methods: Six children (76±15mo) with DS were studied. A standard glucose tolerance test was done. Serum insulin was measured at 30 minute intervals and plasma glucagon at baseline and at the time of hypoglycemia (plasma glucose<50mg/dl). Results: All patients had hyperglycemia followed by hypoglycemia. The mean maximum and minimum plasma glucose values were 211±13 and 40±2 mg/dl. The mean maximum serum insulin level was 174±47 while the mean level at the time of hypoglycemia was 2±0.8 uU/ml. The mean plasma glucagon levels at baseline and at the time of hypoglycemia were 36±4 and 34±6 pg/ml. One patient showed a rise from 21 to 53, another showed an increase from 37 to 47 pg/ml, while the other 4 had a decrease from baseline. The glucose, insulin and glucagon values are shown in the figure. In conclusion, abnormal glucagon release may play an important role in the pathogenesis of hypoglycemia in children with dumping syndrome.