The CNS Control of Glucose Metabolism

In the clinic at Giessen during the last few years there has been an extensive programme of research into the various aspects of lesions of the diencephalon and brain stem and the associated autonomic and metabolic disturbances. As a continuation of this research programme Ernst Grote has investigated the central neuronal and hormonal factors acting on the peripheral regulation of glucose metabolism and their diverse inter-relationships. This research was made possible not only by the availability of well-documented clinical and experi mental material with primary and secondary lesions of the hypo thalamus and brain stem, but also by the advances in clinical endo crinology and the development of radio-immuno-assays. By continuous systematic investigation of the basic values and their reaction to stress-tests, as well as to trauma and operation, he has elucidated the basic facts of the central and peripheral mechanisms which are concerned in the regulation of glucose, and also their disturbances. Of particular significance are his descriptions and interpretations of the characteristic hypothalamic syndromes, as combinations of hyperglycaemia, hyperinsulinaemia and hyperglucagonaemia; dif ferent syndromes are produced by lesions at various levels of the brain stem and in central brain death. From this starting point it was possible to develop a rational treatment of this hormonal dys regulation by means of somatostatin.

Inhalt

1. Introduction.- 2. The Regulation of Glucose Metabolism.- 2.1. Non-Nervous Regulation.- 2.2. Central Nervous Regulation.- 2.3. Summary.- 3. Methods Employed.- 3.1 Standardization of the Withdrawal of Blood.- 3.2 Standardization of the Loading Tests.- 3.3 Chemical Estimation Methods.- 3.4 Pharmacokinetics of Glucose.- 3.5 Statistical Methods.- 4. Results.- 4.1. Survey of Material and Subdivision into Groups.- 4.2. Preliminary Studies.- 4.3. Spontaneous Behaviour.- 4.4. Intravenous Stress with Glucose 0.33 g/kg Body Weight.- 4.5. Mean Hourly Concentrations in the Various Groups, in Response to a Glucose Load.- 4.6. The Molar Insulin-Glucagon Quotient in the Various Groups.- 4.7. Pharmacokinetic Investigation of the Concentration Pattern and of the Assimilation of the Blood Glucose After an Intravenous Glucose Load.- 4.8. Inhibition Tests with Somatostatin.- 5. Consideration of the Results and Discussion.- 6. Summary.- References.