American Journal of Clinical Nutrition, Vol 25, 499-505, Copyright © 1972 by The American Society for Clinical Nutrition, Inc.

Patterns of insulin response to glucose in protein-calorie malnutrition

¹ From the Medical Research Council Clinical Nutrition Research Unit, Department of Paediatrics and Child Health, and the Isotope Unit, Department of Medicine, University of Cape Town, Observatory, Cape Province, South Africa

Patterns of insulin secretion after oral or intravenous glucose, or both, have been studied in 54 children with protein-calorie malnutrition. Generally the immunoreactive insulin curve is flat, corresponding to a gross quantitative deficiency. However, in certain patients, insulin secretion is sustained or delayed after oral or intravenous glucose. The sustained response may represent insulin antagonism. The delayed peak after oral glucose administration is possibly due to a deficiency in gut beta-cytotrophic factors that recover on treatment. This is suggested by a much greater increase, after improvement in nutritional status, of insulin-glucose ratios in response to oral rather than intravenous glucose when similar glycemic stimuli are achieved. However, a disturbance of other factors thought to participate in the mediation of normal insulin release may play an additional role.