Alterations in Insulin Clearance and Hepatic Blood Flow during the Night Do Not Contribute to the &amp;lsquo;Dawn Phenomenon&amp;rsquo; in Type 1 Diabetes

Widmer, Andrea; Keller, U; Pasquel, Miguel; Berger, W

doi:10.1159/000181002

Cited by 8 publications

(3 citation statements)

References 18 publications

(25 reference statements)

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“…Finally, the results of the present studies reaffirm that insulin clearance does not change overnight in Type 1 diabetes mellitus, and does not contribute to the dawn phenomenon, as previously reported [3,13,14]. Notably, in the present experiments, suppression or replacement of nocturnal spikes of growth hormone secretion did not affect insulin clearance.…”

Section: Discussionsupporting

confidence: 92%

“…Theoretically, the dawn phenomenon might be due to either an increase in insulin clearance [9][10][11][12], or to a decrease in insulin sensitivity, or a combination of both factors [8]. Several studies [3,13,14] indicate that insulin clearance does not change overnight. Thus, the dawn phenomenon should be due solely to a decrease in insulin sensitivity [3].…”

Section: Discussionmentioning

confidence: 99%

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Nocturnal spikes of growth hormone secretion cause the dawn phenomenon in Type 1 (insulin-dependent) diabetes mellitus by decreasing hepatic (and extrahepatic) sensitivity to insulin in the absence of insulin waning

et al. 1990

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The aim of the present studies was to test the hypothesis that the dawn phenomenon in Type 1 (insulin-dependent) diabetes mellitus is due to a decrease in insulin sensitivity caused by nocturnal spikes of growth hormone. Twelve subjects with Type 1 diabetes were studied on two different occasions, from 24.00 to 02.00 hours, and from 06.00 to 08.00 hours with the euglycaemic clamp technique at two plasma free insulin levels (approximately 25 mU/l, n = 7; approximately 80 mU/l, n = 5). To eliminate the confounding factor of insulin waning of previous Biostator studies, prior to clamp experiments the diabetic subjects were infused with i.v. insulin by means of a syringe pump according to their minute-to-minute insulin requirements. Insulin sensitivity decreased at dawn as compared to the early night hours (approximately 30% increase in the rate of hepatic glucose production, approximately 25% decrease in the rate of peripheral glucose utilisation). Plasma insulin clearance did not change overnight. In seven Type 1 diabetic subjects, suppression of nocturnal spikes of growth hormone secretion by somatostatin during basal glucagon and growth hormone replacement resulted in complete abolition of the increased rate of hepatic glucose production at dawn. Replacement of nocturnal spikes of growth hormone faithfully reproduced the increase in hepatic glucose production at dawn of the control study.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Nocturnal spikes of growth hormone secretion cause the dawn phenomenon in Type 1 (insulin-dependent) diabetes mellitus by decreasing hepatic (and extrahepatic) sensitivity to insulin in the absence of insulin waning

et al. 1990

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“…Hence, bedtime NPH insulin injected at 22.00–23.00 h begins to lower blood glucose concentrations at 01.00 h, and its effect intensifies at 01.00–03.00 h [ 7, 8]. Meanwhile, physio‐ logical insulin requirements reach a nadir around 01.00–03.00 h [ 9, 10] which, in turn, leads to a high risk for hypoglycaemic episodes around 03.00 h [ 11, 12]. The problems of overnight glycaemia in IDDM are then further complicated by the dawn phenomenon, an increase in insulin needs from 05.00 h to 09.00 h, i.e.…”

Section: Introductionmentioning

confidence: 99%

Bedtime uncooked cornstarch supplement prevents nocturnal hypoglycaemia in intensively treated type 1 diabetes subjects

Axelsen¹,

Wesslau²,

Lönnroth³

et al. 1999

Journal of Internal Medicine

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Abstract. Axelsen M, Wesslau C, Lönnroth P, Arvidsson Lenner R, Smith U (Sahlgrenska University Hospital, Göteborg University, Sweden). Bedtime uncooked cornstarch supplement prevents nocturnal hypoglycaemia in intensively treated IDDM subjects. J Intern Med 1999; 245: 229-36.Objectives. The present study tests two interrelated hypotheses: (1) that bedtime ingestion of uncooked cornstarch exerts a lower and delayed nocturnal blood glucose peak compared with a conventional snack; (2) that bedtime carbohydrate supplement, administered as uncooked cornstarch, prevents nocturnal hypoglycaemia without altering metabolic control in intensively treated type 1 diabetes (IDDM) patients. Design and subjects. The above hypotheses were tested separately (1) by pooling and analysing data from two overnight studies of comparable groups of patients with non-insulin dependent diabetes mellitus (NIDDM) (14 and 10 patients, respectively), and (2) by a double-blind, randomized 4-week cross-over study in 12 intensively treated IDDM patients. Setting. Sahlgrenska University Hospital, Göteborg, Sweden. Interventions.(1) Ingestion of uncooked cornstarch and wholemeal bread (0.6 g of carbohydrates kg Results. Bedtime uncooked cornstarch ingestion led to a lower (2.9 Ϯ 0.5 vs. 5.2 Ϯ 0.6 m, P = 0.01) and delayed (4.3 Ϯ 0.6 vs. 2.0 Ϯ 0.0 h, P Ͻ 0.01) BG peak, compared with a conventional snack, in NIDDM patients. Four weeks of bedtime uncooked cornstarch supplement, as compared with placebo, led to a 70% reduction in the frequency of self-estimated hypoglycaemia at 03.00 h (P Ͻ 0.05), without affecting HbA1c or fasting lipids in IDDM patients. Conclusions. Uncooked cornstarch, ingested at bedtime, mimicked the nocturnal glucose utilization profile following insulin replacement, with a peak in blood glucose after 4 h. In IDDM patients, bedtime uncooked cornstarch supplement diminished the number of self-estimated hypoglycaemic episodes, without adversely affecting HbA1c and lipid levels. Hence, bedtime uncooked cornstarch ingestion may be feasible to prevent a mid-nocturnal glycaemic decline following insulin replacement in IDDM and, based on the nocturnal blood glucose profile, may also be preferable compared with conventional snacks.

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Chronobiology, Nutrition, and Diabetes Mellitus

Méjean¹,

Kolopp²,

Drouin³

1992

Biologic Rhythms in Clinical and Laboratory Medicine

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Alterations in Insulin Clearance and Hepatic Blood Flow during the Night Do Not Contribute to the ‘Dawn Phenomenon’ in Type 1 Diabetes

Cited by 8 publications

References 18 publications

Nocturnal spikes of growth hormone secretion cause the dawn phenomenon in Type 1 (insulin-dependent) diabetes mellitus by decreasing hepatic (and extrahepatic) sensitivity to insulin in the absence of insulin waning

Nocturnal spikes of growth hormone secretion cause the dawn phenomenon in Type 1 (insulin-dependent) diabetes mellitus by decreasing hepatic (and extrahepatic) sensitivity to insulin in the absence of insulin waning

Bedtime uncooked cornstarch supplement prevents nocturnal hypoglycaemia in intensively treated type 1 diabetes subjects

Chronobiology, Nutrition, and Diabetes Mellitus

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