Massive Insulin Secretion in Response to Anaerobic Exercise in Exercise-induced Hyperinsulinism

T. Meissner; B. Friedmann; J. G. Okun; M. A. Schwab; T. Otonkoski; T. Bauer; P. Bärtsch; E. Mayatepek

doi:10.1055/s-2005-870583

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2005; 37(11): 690-694
DOI: 10.1055/s-2005-870583

Original Clinical

Massive Insulin Secretion in Response to Anaerobic Exercise in Exercise-induced Hyperinsulinism

T. Meissner¹ , B. Friedmann² , J. G. Okun³ , M. A. Schwab³ , T. Otonkoski⁴ , T. Bauer² , P. Bärtsch² , E. Mayatepek¹

¹Department of General Pediatrics, University Children’s Hospital, Düsseldorf, Germany
²Department of Sports Medicine, Medical Clinic and Policlinic, University of Heidelberg, Germany
³Division of Inherited Metabolic Diseases, University Children’s Hospital, Heidelberg, Germany
⁴Hospital for Children and Adolescents and the Haartman Institute, University of Helsinki, Finland

Abstract

Exercise-induced hyperinsulinism (EIHI) is a recently described entity characterised by recurrent episodes of hypoglycaemia induced by physical exercise. The index patient for this disorder and a matched control were subjected to aerobic and anaerobic exercise tests on a cycle ergometer. Aerobic exercise was performed at an intensity of 60 % of the respective 4 mmol/l lactate threshold (40 min). Anaerobic exercise with an intensity corresponding to 130 % VO₂ _max lead to exertion within 2 - 3 min and elicited comparable maximal lactate levels in both subjects (10 - 11 mmol/l). The patient experienced a massive increase in insulin from 34 to 649 mU/l after the anaerobic test, and a lower increase in insulin from 27 to 79 mU/l during the aerobic test. Insulin concentration remained unchanged during both tests in the control. Epinephrine increased in the EIHI patient, which was probably a counterregulatory response to hypoglycaemia. The activity of lactate dehydrogenase of the index patient in isolated leukocytes as well as the response to inhibition of oxamate was normal. The hypothesis of abnormal transport or metabolism of lactate/pyruvate in the β-cells of patients with EIHI was further supported by the parallel increase of lactate and insulin in this study elicited in particular by anaerobic exercise.

Key words

Congenital hyperinsulinism - hypoglycaemia - workload - lactate dehydrogenase - epinephrine

Full Text

References

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Dr. Thomas Meissner, M. D.

Department of General Pediatrics

University Children’s Hospital · Moorenstraße 5 · 40225 Düsseldorf · Germany

Phone: +49 (211) 811 76 87

Fax: +49 (211) 811 87 57 ·

Email: thomas.meissner@med.uni-duesseldorf.de