Effects of insulin on the response of immunoreactive glucagon to an intravenous glucose load in human diabetes

The effects of exogenous insulin upon the response of immunoreactive glucagon (IRG) to i.v. glucose were studied in diabetic and nondiabetic subjects. In nondiabetics, a rapid injection of 25 g of glucose lowered plasma IRG levels. In adult-onset diabetics, the glucose-induced decline in IRG was normal despite a subnormal glucose-induced insulin rise, in contrast to impaired IRG suppressibility previously reported when such patients received an oral glucose load. The magnitude of their glucose-induced IRG decline was not augmented by exogenous insulin, even when insulin levels were acutely raised above 300 μU/ml. In juvenile-type diabetics, basal IRG levels were normal following overnight insulin infusion, but the glucose-induced IRG decline was only half that of the nondiabetics. However, it became normal when hyperinsulinemia was acutely produced by supplementary insulin. Thus, whenever insulin levels rise in response to an increase in hyperglycemia, as they do spontaneously in nondiabetics and in adult-type diabetics and as they do when juvenile diabetics are given supplementary insulin together with the glucose bolus, the decline in IRG in response to an i.v. glucose load is as great as in nondiabetics. The findings are compatible with the view that glucose-induced suppression of IRG may require a concomitant rise in insulin.