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Glucose, insulin and somatostatin infusion over 2 hours effectively suppressed endogenous secretion of insulin, glucagon and growth hormones. Steady state plasma glucose level (SSPG) which should be inversely proportional to insulin sensitivity was obtained. In 6 adult-onset non-obese untreated diabetics, mean value of insulin sensitivity indices was significantly reduced compared with normal. In 5 insulin-treated diabetics and in 5 subjects with borderline glucose tolerance including 2 obese subjects, insulin sensitivity for glucose utilization was also significantly diminished.

Abstract.A new cookie test was developed for the simultaneous evaluation of multiple risk factors such as glucose intolerance, hyperinsulinemia, insulin resistance and postprandial dyslipidemia. The cookie consisting of 75 g carbohydrate and 25 g fat is ingested and the blood samples are obtained at 0, 1 and 2 hours later. When the two carbohydrate sources, liquid glucose and test cookie, were compared as a glucose load within 3 months, the 2 hr plasma glucose levels were not statistically different, proposing the use of the same criteria at 2 hour glucose level for the diagnosis of diabetes and impaired glucose tolerance (IGT) in subjects without exocrine pancreatic dysfunction. In addition, hyperinsulinemia, insulin resistance (AUC insulin, and/or AUC insulin X AUC glucose), and postprandial hyperlipidemia (DTG, Triglyceride; DRLP, remnant like particles) have been simultaneously uncovered. Reactive hypoglycemia with adverse epigastric discomfort was observed in 26.3% of the control subjects with liquid glucose, while it was observed in only 1 case (5.3%) without any symptom with cookie tests. In fact, one reactive hypoglycemia out of 5 with liquid glucose turned out to be IGT with cookie test. In 64 subjects with lifestyle-related diseases, cookie test revealed hyperinsulinemia and insulin resistance in 56% respectively, postprandial hyperlipidemia in 39%, diabetes and IGT in 22-23% of each of the subjects and all showed at least one abnormal value. In contrast, in university students with exercise habit, all showed normal results with cookie test. In addition, improved insulin sensitivity over non-exercise group was obverved. In summary, the cookie test provided more informations compared with OGTT using liquid glucose and with fewer side effects. Simultaneous evaluation of glucose intolerance, hyperinsulinemia, insulin resistance, and postprandial hyperlipidemia was also possible. SIMULTANEOUS determination of glucose intolerance including diabetes mellitus (DM), hyperinsulinemia, insulin resistance and postprandial dyslipidemia is beneficial for the early detection of metabolic factors involved in the lifestyle-related diseases [1]. Oral glucose tolerance test (OGTT) can reveal glucose intolerance, hyperinsulinemia, and apparent insulin resistance [2], but false reactive hypoglycemia has often been observed with adverse epigastric symptoms and does not reflect the daily blood glucose excursion and insulin responses. The cookie was ingested and the blood glucose, insulin and TG or RLP responses were measured in the newly developed cookie test. With the exception of exocrine pancreatic dysfunction, starch and 15% maltose are thought to be well digested and no significant difference has been reported for the postprandial 2 hr blood glucose levels [3]. Thus after ingestion of the cookie, postprandial hyperglycemia using the same criteria as OGTT, as well as postprandial dyslipidemia can be simultaneously evaluated. Measurement of endogenous insulin gives additional information regarding hyperinsulinemia and in...