-The biphasic pattern of glucose-induced insulin secretion is altered in type 2 diabetes. Impairment of the first phase is an early sign of -cell dysfunction, but the underlying mechanisms are still unknown. Their identification through in vitro comparisons of islets from diabetic and control subjects requires characterization and quantification of the dynamics of insulin secretion by normal islets. When perifused normal human islets were stimulated with 15 mmol/l glucose (G15), the proinsulin/insulin ratio in secretory products rapidly and reversibly decreased (ϳ50%) and did not reaugment with time. Switching from prestimulatory G3 to G6 -G30 induced biphasic insulin secretion with flat but sustained (2 h) second phases. Stimulation index reached 6.7-and 3.6-fold for the first and second phases induced by G10. Concentration dependency was similar for both phases, with halfmaximal and maximal responses at G6.5 and G15, respectively. First-phase response to G15-G30 was diminished by short (30 -60 min) prestimulation in G6 (vs. G3) and abolished by prestimulation in G8, whereas the second phase was unaffected. After 1-2 days of culture in G8 (instead of G5), islets were virtually unresponsive to G15. In both settings, a brief return to G3-G5 or transient omission of CaCl2 restored biphasic insulin secretion. Strikingly, tolbutamide and arginine evoked immediate insulin secretion in islets refractory to glucose. In conclusion, we quantitatively characterized the dynamics of glucose-induced insulin secretion in normal human islets and showed that slight elevation of prestimulatory glucose reversibly impairs the first phase, which supports the view that the similar impairment in type 2 diabetic patients might partially be a secondary phenomenon. human islets; insulin secretion; biphasic pattern; type 2 diabetes; proinsulin GLUCOSE HOMEOSTASIS depends on a precise quantitative and temporal regulation of insulin secretion by pancreatic -cells. When the concentration of glucose is rapidly and steadily increased, insulin secretion displays a biphasic time course. This peculiar dynamic was suspected from measurements of insulin in peripheral and portal blood in humans (4, 10) and convincingly established by in vitro experiments using the perfused rat pancreas and perifused islets (12, 41). Experimental studies in rodents have variably attributed the biphasic pattern to the release of distinct pools of insulin granules or to the time course of intracellular signals, in particular free cytosolic Ca 2ϩ , in -cells (see reviews in Refs. 28,51,60,62,and 63).Although blood glucose concentrations never increase rapidly enough to induce biphasic insulin secretion in daily life, the pattern is a most sensitive expression of adequate -cell functioning (9). Pioneer studies measuring changes in plasma insulin after intravenous bolus administration of glucose and more recent ones calculating the insulin secretion rate by deconvolution of C-peptide concentrations during hyperglycemic clamps have established that impairment of the f...