Metabolic Homeostasis in Juvenile Diabetes Mellitus: II. Increased Ketone Responsiveness to Epinephrine

Abstract

A series of epinephrine infusions were performed to study the possible role of catecholamines in the observed metabolic lability of juvenile diabetics. The data obtained in twenty insulin dependent juvenile diabetics were compared with the results obtained in eleven normal children. Glucose and free fatty acid concentrations rose sharply in the diabetic group at the start of the epinephrine infusion, despite initial concentrations that were markedly elevated. The most striking difference between the diabetic children and the normal group, however, was seen in the blood ketone response. There appeared to be an increased ketone responsiveness to epinephrine stimulation in the diabetic child documented by the rate and magnitude of the ketone elevation, and by the absence of any lag period between the start of the epinephrine infusion and the rise of the blood ketone concentration. Increased ketone responsiveness to epinephrine would appear to be an important characteristic of the juvenile diabetic. The ketone rise can be blocked by acute beta adrenergic blockade, indicating the dependence of the ketone rise on free fatty acid mobilization. The possible importance of hepatic triglycerides in diabetic ketosis is discussed.