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Cited by 34Diabetes Management and ResearchPancreatic function and diabetesDietary Effects on Health

The DOI matches its Crossref record; 12 of the 12 references it cites were found in a registry or an index.

Increasing Serum Betahydroxybutyrate Concentrations during the 72-Hour Fast: Evidence against Hyperinsulinemic Hypoglycemia

Service, F. John, O’Brien, Peter C.·2005·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2005-0033
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Abstract

OBJECTIVE: We have determined whether the behavior of betahydroxybutyrate (BOHB) during the 72-h fast of persons without evidence of hyperinsulinemic or any form of organic hypoglycemia might provide indicators of a negative fast. DESIGN: Twenty-one patients with surgically confirmed insulinoma and 34 patients with negative 72-h fasts had BOHB measured every 6 h until Whipple's triad in the former and until 72-h in the latter. RESULTS: Quadratic regression curves of BOHB from the negative fasts showed the typical curve to be flat initially, then increase in a manner that was roughly linear. Using time-specific medians, the changes were: 12-18 h, 0% increase; 18-36 h, 333% increase; 36-54 h, 210% increase, and 54-72 h, 167% increase. In contrast, patients with insulinoma had suppressed BOHB concentrations. Two successive BOHB values in excess of the 18-h level seemed to portend a negative fast. By using the previously published criterion of BOHB more than 2.7 mmol/liter (a surrogate for hypoinsulinemia and thereby an indicator of a negative fast), 74% of persons with a negative fast reached this level before the 72-h point. CONCLUSIONS: Serial measurements of BOHB during the 72-h fast have the potential to provide not only clues during the fast that it will ultimately be negative, but also the opportunity to truncate the fast if the endpoint BOHB criterion for a negative fast is met before 72 h.

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  • Plasma beta-hydroxybutyrate levels of 2.7 mmol/liter or less and an increase in plasma glucose concentration of at least 25 mg/dl after iv glucagon provide biological evidence of insulin (or IGF) excess.

    “Plasma ␤-hydroxybutyrate levels of 2.7 mmol/liter or less and an increase in the plasma glucose concentration of at least 25 mg/dl (1.4 mmol/ liter) after iv glucagon, the latter indicating preserved hepatic glycogen stores, provide biological evidence of insulin (or IGF) excess (62).”

    From Evaluation and Management of Adult Hypoglycemic Disorders: An Endocrine Society Clinical Practice Guideline (2009) · cites this paper as [62]

    The Abstract describes beta-hydroxybutyrate as an insulin surrogate and identifies levels above 2.7 mmol/liter as a criterion for a negative 72-hour fast; it also reports suppressed levels in patients with insulinoma. This supports the low-beta-hydroxybutyrate part in the fasting context, but our copy does not state the claimed ≥25 mg/dl response to intravenous glucagon, its hepatic-glycogen interpretation, or the extension to IGF excess. (LLM, conf=0.86)

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  1. [5]5. Threatte GA, Henry JB 1996 Carbohydrates. In: Clinical diagnosis and man- agement of laboratory methods. Henry JB, ed. 19th ed. Philadelphia: WB Saunders

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Metadata

Authors
Service, F. J., & O’Brien, P. C.
Affiliations
Mayo Clinic (US)
Corresponding author
Service, F. John
ORCID
O’Brien, Peter C.
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2005-08
Volume
90
Issue
8
Pages
4555-4558
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2005-0033
OpenAlex
W2155776038
Cited by
34
References
12
Citations by year
2025: 1 · 2024: 4 · 2023: 1 · 2022: 2 · 2021: 2 · 2019: 1 · 2018: 1 · 2017: 1 · 2015: 1 · 2013: 4 · 2012: 2
FWCI
1.46
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pancreatic function and diabetes
  • Health Sciences › Medicine › Physiology (medical) › Dietary Effects on Health
Keywords
beta-hydroxybutyrate, hyperinsulinemic hypoglycemia, insulinoma, hypoinsulinemia, Whipple's triad, ketogenesis
MeSH terms
Adult, Aged, Fasting, Female, Humans, Hyperinsulinism, Hypoglycemia, Insulinoma, Male, Middle Aged, Pancreatic Neoplasms, Regression Analysis, Retrospective Studies, Biomarkers, 3-Hydroxybutyric Acid

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