Diagnostic Accuracy of an “Amended” Insulin–Glucose Ratio for the Biochemical Diagnosis of Insulinomas
Authors: Michael A. Nauck, Jurus J. Meier
Journal: Annals of Internal Medicine (2013)

Letters19 March 2013Diagnostic Accuracy of an “Amended” Insulin–Glucose Ratio for the Biochemical Diagnosis of InsulinomasMichael A. Nauck, MD and Jurus J. Meier, MDMichael A. Nauck, MDFrom Diabeteszentrum Bad Lauterberg, Harz, and Ruhr-Universität Bochum, Bochum, Germany.Search for more papers by this author and Jurus J. Meier, MDFrom Diabeteszentrum Bad Lauterberg, Harz, and Ruhr-Universität Bochum, Bochum, Germany.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-6-201303190-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We thank Dr. Cryer and colleagues from the Endocrine Society Task Force on the Evaluation and Management of Adult Hypoglycemic Disorders for their comments on our article. We would like to make clear that the assumption that insulin secretion ceases at a plasma glucose concentration of 1.7 mmol/L (30 mg/dL) (1) probably does not represent the true concentration–response relationship in human participants in vivo (2), but it was the basis for suggesting the “amended” insulin–glucose ratio for diagnostic purposes. Dr. Cryer and colleagues also correctly point out that the diagnostic sensitivity of this ratio for the diagnosis of ...References1. Turner RC, Oakley NW, Nabarro JD. Control of basal insulin secretion, with special reference to the diagnosis of insulinomas. Br Med J. 1971;2:132-5. [PMID: 4325738] CrossrefMedlineGoogle Scholar2. Schwartz NS, Clutter WE, Shah SD, Cryer PE. Glycemic thresholds for activation of glucose counterregulatory systems are higher than the threshold for symptoms. J Clin Invest. 1987;79:777-81. [PMID: 3546378] CrossrefMedlineGoogle Scholar3. Nauck MA, Heimesaat MM, Behle K, Holst JJ, Nauck MS, Ritzel R, et al. Effects of glucagon-like peptide 1 on counterregulatory hormone responses, cognitive functions, and insulin secretion during hyperinsulinemic, stepped hypoglycemic clamp experiments in healthy volunteers. J Clin Endocrinol Metab. 2002;87:1239-46. [PMID: 11889194] CrossrefMedlineGoogle Scholar4. DeFronzo RA, Binder C, Wahren J, Felig P, Ferrannini E, Faber OK. Sensitivity of insulin secretion to feedback inhibition by hyperinsulinaemia. Acta Endocrinol (Copenh). 1981;98:81-6. [PMID: 7025544] CrossrefMedlineGoogle Scholar5. Boden G. Free fatty acids and insulin secretion in humans. Curr Diab Rep. 2005;5:167-70. [PMID: 15929861] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Diabeteszentrum Bad Lauterberg, Harz, and Ruhr-Universität Bochum, Bochum, Germany.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0539. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDiagnostic Accuracy of an “Amended” Insulin–Glucose Ratio for the Biochemical Diagnosis of Insulinomas Michael A. Nauck and Juris J. Meier Diagnostic Accuracy of an “Amended” Insulin–Glucose Ratio for the Biochemical Diagnosis of Insulinomas Philip E. Cryer , Lloyd Axelrod , Ashley B. Grossman , Simon R. Heller , Elizabeth R. Seaquist , F. John Service , and Metrics Cited byFrom obesity to diabetes and cancer: epidemiological links and role of therapies 19 March 2013Volume 158, Issue 6Page: 501-502KeywordsAttentionBlood plasmaFatty acidsGlucoseHyperinsulinemiaHypoglycemiaHypoglycemicsInsulin secretionInsulinomaSurgery ePublished: 19 March 2013 Issue Published: 19 March 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...