Therapeutic insulin and hepatic glucose-6-phosphatase activity in preterm infants
A Burchell, A McGeechan, R Hume
Departments of
Obstetrics and Gynaecology and Child Health, Tayside Institute of Child
Health, Ninewells Hospital and Medical School, University of Dundee,
Dundee DD1 9SY, Scotland, UK
Correspondence to: Dr Burchell email: a.burchell{at}dundee.ac.uk
Accepted 14 September
1999
BACKGROUND
Hepatic
glucose-6-phosphatase activity is low at birth, and in term infants
rises rapidly to adult levels. In contrast, in most preterm infants, it
remains low postnatally making them vulnerable to repeated
hypoglycaemic episodes, resultant cerebral damage, or risk of sudden
and unexpected death.
AIMSTo investigate
the clinical features of preterm infants with low glucose-6-phosphatase
enzyme activity to determine the influencing factors.
METHODSClinical data
from 36 preterm infants were correlated by stepwise multiple regression
analysis with Vmax of hepatic glucose-6-phosphatase as the
dependent variable.
RESULTSThe most
significant correlation was with the administration of insulin
(units/kg/h postnatal life) with lesser effects of respiratory distress
syndrome and dopamine administration. The Vmax changes
reflected changes in the level of expression of the glucose-6-phosphatase protein.
CONCLUSIONIn a
variety of animal models, hepatic glucose-6-phosphatase levels have
been shown to decrease in response to insulin, which also decreases
transcription of the glucose-6-phosphatase gene. The association of
insulin administration with high levels of hepatic
glucose-6-phosphatase activity and protein expression was therefore
most unexpected. Results from model systems, or adults, must be
extrapolated to the metabolism of preterm infants with caution.
Keywords: preterm; glucose; insulin; glucose-6-phosphatase
© 2000 by Archives of Disease in Childhood
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This article has been cited by other articles:
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Jackson, L, Burchell, A, McGeechan, A, Hume, R
(2003). An inadequate glycaemic response to glucagon is linked to insulin resistance in preterm infants?. Arch. Dis. Child. Fetal Neonatal Ed.
88: F62-66
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