GLUCOSE-METABOLISM IN CACHECTIC PATIENTS WITH COLORECTAL-CANCER

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  • 1 January 1984
    • journal article
    • research article
    • Vol. 44  (12) , 5910-5913
Abstract
A defined group of 12 weight-losing patients with metastatic colorectal cancer was studied to evaluate the occurrence of and possible relationship between those determinants of carbohydrate metabolism which have been reported to occur commonly in cancer cachexia. The rates of endogenouus glucose production and recycling via lactate (Cori cycle) were measured following an infusion of 50-100 .mu.Ci of [1-14C]glucose. Compared to an age-related group of control subjects without cancer, significantly elevated rates of glucose production [136.4 .+-. 9.0 (SE) vs. 101.0 .+-. 4.6 mg/kg per h; P < 0.01] and recycling (43.0 .+-. 7.2 vs. 15.4 mg/kg per h P < 0.01) were observed. Values for glucose production and recycling ranged from normal to markedly elevated. Glucose tolerance was then determined following a p.o. glucose load of 40 g/s m2 in 10 of the 12 patients. Compared to control subjects, all showed a significantly delayed clearance of glucose (P < 0.01) and a blunted insulin-secretory responsiveness (P < 0.025). Increased glucose production and recycling was only observed in the presence of carbohydrate intolerance, but the latter occurred in a manner which seemed independent of the rate of glucose turnover. In order to obtain an estimate of hepatic glycogen reserves, glucagon, 15 ng/kg per min, was infused over 40 min in 7 subjects. A significantly blunted glycemic response was observed in the cancer patients compared to controls (.DELTA.25.0 .+-. 6.9 vs. 57.8 .+-. 8.5 mg/dl; P < 0.025). Neither the rate of glucose production nor the glycemic response to glucagon appeared to correlate with the immediate antecedent caloric intake. An apparent relationship was observed, however, between increased glucose production and recycling and a lack of response to infused glucagon, probably reflecting decreased glycogen stores in the face of an increased glucose requirement by the patient. Diverse abnormalities of carbohydrate metabolism commonly occur in cancer cachexia and significant metabolic heterogeneity may be expected, despite a uniform diagosis. These results should prove useful in the interpretation and development of clinical studies on cancer cachexia.