Experience with a Steroid-Tolbutamide Test for the Detection of Impaired Pancreatic Reserve

A procedure utilizing a combination of pretreatment with oral steroids followed by intravenous tolbutamide has been described and performed safely in 152 subjects with normal glucose tolerance tests. Criteria for an abnormal response include two of the following three findings: 1. a fasting blood glucose level over 113 mg. per 100 ml.; 2. thirty minutes after the tolbutamide, a fall in glucose of less than 16 per cent; 3. failure of the ninety-minute glucose to rise 4 mg. per 100 ml. above the lowest recorded glucose. Using these criteria an increase in abnormal responses has been found in: I. young individuals with a positive family history of diabetes, 2. individuals over the age of sixty, and 3. patients with peripheral vascular disease or significant obesity. Seven of the abnormal responders have developed overt diabetes in a five-year period. None of the negative responders has become diabetic. Eighteen thyrotoxic subjects were studied and revealed some unusual findings.