Mechanism of action of insulin hypoglycemia on gastric secretion in man

¹ Samuel S. Fels Research Institute, Temple University Medical Center, Philadelphia, Pennsylvania

The effect of insulin hypoglycemia on acid output of gastric secretion over 5-hour periods was studied in eighteen patients with duodenal ulcer, five patients before and after vagotomy and two patients before and after bilateral total adrenalectomy. Results of this study show three components of the mechanism of action of insulin hypoglycemia on gastric secretion, an initial inhibitory effect on basal gastric secretion, a stimulating effect mediated through the vagus nerve responsible for the early phase of secretion (1st and 2nd hr.) and. a gastric secretory response mediated through the adrenal glands manifested in the late phase of secretion (3rd– 5th hr.). However, the magnitude of this late phase of gastric secretion was considerably less pronounced after vagotomy. It appears that a maximal response of this phase of gastric secretion following insulin hypoglycemia dependent on the adrenal gland is also dependent upon an intact vagal mechanism. A significant hypoglycemia of 40 mg % or less was necessary to produce the late phase of gastric secretion. The adrenal phase can contribute to the potential for ulcer occurrence or reactivation, not so much through the increase in secretion it alone might induce, since this is small, but of greater importance in its synergistic action with the vagal mechanism.

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