Hyperglucagonemia in diabetic ketoacidosis. Its prevalence and significance

The prevalence of hyperglucagonemia was studied in twenty-six consecutive patients admitted to Dallas hospitals in diabetic ketoacidosis. Plasma glucagon averaged 390 pg/ml, ranging from 120 to 1,290 pg/ml, significantly greater than the fasting level of 118 pg/ml in diabetic subjects without ketoacidosis. Absolute hyperglucagonemia, i.e., levels over 240 pg/ml, was present in sixteen; all had "relative hyperglucagonemia." Glucagon levels declined after four hours of therapy and were normal at discharge. The plasma glucagon level was significantly correlated with the blood glucose level, respiratory rate and hours of insulin therapy required to correct the ketonemia. Patients with absolute hyperglucagonemia required significantly more insulin than patients without absolute hyperglucagonemia. The results indicate that glucagon excess is present in most patients hospitalized with diabetic ketoacidosis and are compatible with the view that glucagon, an insulin-opposing hormone, may increase the severity of the disease and its insulin requirements.