A B S T R A C T Prednisone-induced insulin resistance may depend on either reduced sensitivity (receptor defect) or reduced response to insulin (postreceptor defect). To clarify the mechanism of prednisone-induced insulin resistance, a [3H]glucose infusion (1 ,uCi/ min) was performed for 120 min before and during a euglycemic clamp repeated at 100, -1,000, and -10,000 MU/ml steady state plasma insulin concentration in 10 healthy, normal weight subjects, aged 35±7 yr. Each test was repeated after 7-d administration of placebo or prednisone (15 plus 15 mg/d per subject), in a randomized sequence with an interval of 1 mo between the two tests. Mean fasting blood glucose (89.5±2.1 vs. 83.7± 1.9 mg/dl) and mean fasting plasma insulin values (17.8±1.2 vs. 14.3±0.8 AU/ml) were significantly higher (P < 0.01) after prednisone. The insulin sensitivity index (glucose metabolic clearance rate in ml/kg per min) was significantly lower (P < 0.001) after prednisone at all three steady state plasma insulin levels: 2.8±0.3 vs. 7.4±1.1 at '100 MU/ml; 6.0±0.5 vs. 12.2±1.1 at -1,000 psU/ml; 7.4±0.6 vs. 14.4±0.5 at -10,000 ,uU/ml. Fasting glucose production (in mg/ kg per min) was significantly higher after prednisone: 3.7±0.2 vs. 2.9±0.2, P < 0.001. Suppression of glucose production at steady state plasma insulin level of -100 IAU/ml was less after prednisone (1.01±0.35 vs. 0.14±0.13, NS), and total at -1,000 and -10,000 1uU/ ml after both prednisone and placebo. The metabolic kinetic parameters of insulin after prednisone were not significantly different from those after placebo. In addition, insulin binding and 3-ortho-methyl-glucose transport were studied in vitro on fat cells from 16 normal-weight surgical candidates aged 40±8 yr (10
Fewer than 20 % of T1DM patients are free from hypoglycemia, with one in six having experienced at least one severe episode in the last year. The distribution is uneven, with a tendency of episodes to cluster in some patients. Severe and symptomatic episodes have different correlates and reflect different conditions.
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