Dual‐hormone treatment with insulin and glucagon in patients with type 1 diabetes

Reiband, Hanna K; Schmidt, Signe; Ranjan, Ajenthen; Holst, Jens J.; Madsbad, Sten; Nørgaard, Kirsten

doi:10.1002/dmrr.2632

Cited by 16 publications

(17 citation statements)

References 88 publications

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“…Peak plasma glucagon responses occurred at mean (95% CI) 12 (10-15), 14 (11)(12)(13)(14)(15)(16) and 16 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) min after 100, 200 and 300 μg glucagon administration and with mean (95% CI) levels of 100 (47-152), 217 (118-317) and 358 (190-526) pmol/l (p < 0.0001), respectively ( Figure 2). Furthermore, peak glucagon was inversely correlated with weight (r = 0.2, −0.22 pmol/l × kg; p = 0.0002) and positively correlated with duration of diabetes (r = 0.2, 0.19 pmol/l × years; p = 0.007…”

Section: Glucagonmentioning

confidence: 99%

Effects of subcutaneous, low‐dose glucagon on insulin‐induced mild hypoglycaemia in patients with insulin pump treated type 1 diabetes

Ranjan

Schmidt

Madsbad

et al. 2016

Diabetes Obesity Metabolism

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Section: Glucagonmentioning

confidence: 99%

Effects of subcutaneous, low‐dose glucagon on insulin‐induced mild hypoglycaemia in patients with insulin pump treated type 1 diabetes

Ranjan

Schmidt

Madsbad

et al. 2016

Diabetes Obesity Metabolism

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“…Would it be possible to design a treatment regimen for insulin-dependent diabetic patients taking into consideration that failure of glucagon release, especially after a recent, severe hypoglycemic event? While there is current interest in dual hormone treatment with insulin and glucagon (18), significant delivery problems have slowed development, none the least of which is the relative insolubility of glucagon. The technology requires constant glucose surveillance and the appropriate sensors and servomechanisms have yet to be developed.…”

Section: 1 Neuronostatin As a Potential Co-therapy For The Preventimentioning

confidence: 99%

Hypoglycemia unawareness prevention: Targeting glucagon production

Samson

Stein

Elrick

et al. 2016

Physiology & Behavior

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Insulin-dependent individuals with diabetes are at risk for a severe hypoglycemic event that may predispose them to several repeat episodes during which the normal counter regulatory mechanisms that protect against hypoglycemia fail to be activated. This state of hypoglycemia unawareness is characterized by a failure of glucagon release, preventing mobilization of endogenous glucose stores from the liver. We describe the discovery of a novel hormone, produced in pancreatic delta cells, which stimulates glucagon production and release, particularly under low glucose conditions. We hypothesize that this hormone, called neuronostatin, may be effective as a co-therapy with insulin to prevent repeated, potentially fatal episodes of recurrent hypoglycemia.

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“…104,105]. There are several recent reviews of artificial pancreas bihormonal therapy [106][107][108][109]. There are several recent reviews of artificial pancreas bihormonal therapy [106][107][108][109].…”

Section: Use Of Glucagon In Artificial Pancreas Bihormonal Type 1 Diamentioning

confidence: 99%

Glucagon – the new ‘insulin’ in the pathophysiology of diabetes

Farhy

McCall

2015

Current Opinion in Clinical Nutrition and Metabolic Care

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Purpose of review Autoimmune destruction of the b cells is considered the key abnormality in type 1 diabetes mellitus and insulin replacement the primary therapeutic strategy. However, a lack of insulin is accompanied by disturbances in glucagon release, which is excessive postprandially, but insufficient during hypoglycaemia. In addition, replacing insulin alone appears insufficient for adequate glucose control. This review focuses on the growing body of evidence that glucagon abnormalities contribute significantly to the pathophysiology of diabetes and on recent efforts to target the glucagon axis as adjunctive therapy to insulin replacement. Recent findingsThis review discusses recent (since 2013) advances in abnormalities of glucagon regulation and their link to the pathophysiology of diabetes; new mechanisms of glucagon action and regulation; manipulation of glucagon in diabetes treatment; and analytical and systems biology tools to study glucagon regulation. SummaryRecent efforts 'resurrected' glucagon as a key hormone in the pathophysiology of diabetes. New studies target its abnormal regulation and action that is key for improving diabetes treatment. The progress is promising, but major questions remain, including unravelling the mechanism of loss of glucagon counterregulation in type 1 diabetes mellitus and how best to manipulate glucagon to achieve more efficient and safer glycaemic control. adequate glucose control. Thus, recent efforts have been focused on manipulating glucagon either alone or as adjunctive therapy to insulin replacement. This work reviews recent advances in abnormal glucagon regulation and its link to the pathophysiology of diabetes; novel mechanisms of glucagon action and regulation; glucagon manipulation in diabetes treatment; and analytical and systems biology tools to study glucagon regulation.

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Dual‐hormone treatment with insulin and glucagon in patients with type 1 diabetes

Cited by 16 publications

References 88 publications

Effects of subcutaneous, low‐dose glucagon on insulin‐induced mild hypoglycaemia in patients with insulin pump treated type 1 diabetes

Effects of subcutaneous, low‐dose glucagon on insulin‐induced mild hypoglycaemia in patients with insulin pump treated type 1 diabetes

Hypoglycemia unawareness prevention: Targeting glucagon production

Glucagon – the new ‘insulin’ in the pathophysiology of diabetes

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