In eleven male patients with flame injury (all believed to be non-diabetic before injury) initial glucagon levels were increased despite administration of intravenous glucose. Values ranged from 185 to 662 pg. per ml. and averaged 327±42 pg. per ml. (mean±S.E.M.). They were significantly higher than the mean fasting levels in normal subjects (75 ±4 pg. per ml.). Insulin levels varied widely, but tended to be low in relation to the simultaneously measured blood-glucose level, which ranged from 95 to 205 mg. per 100 ml. In six patients the insulin/glucagon ratio was below 2'- i.e., the range observed in other catabolic states- despite the glucose infusion, while in ten patients it was below the levels normally attained during glucose administration. Among the survivors wound closure and weight stabilisation coincided with a rise in the insulin/glucagon ratio to or above normal. The findings suggest that the islets of Langerhans participate in the metabolic response to burns.
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