Gastric emptying and postprandial glucose excursions in adolescents with type 1 diabetes

Abstract

Because amylin is co-secreted with insulin from beta cells, patients with type 1 diabetes (T1DM) are deficient in both insulin and amylin. Amylin delays gastric emptying and suppresses glucagon in the postprandial period. Hence, we hypothesized that children with complication-naive T1DM have accelerated gastric emptying in response to a mixed meal because of amylin deficiency. Amylin, glucagon, insulin, glucose, and gastric emptying were measured in seven T1DM and in eight control subjects without diabetes. Subjects with T1DM had markedly elevated glucose concentrations when compared with controls (p < 0.0001). Amylin concentrations as predicted were lower in T1DM compared with those in controls (p < 0.0001). Insulin did not peak in the immediate postprandial period in T1DM when compared with controls (p < 0.0001). Glucagon concentrations did not significantly differ between groups. Interestingly, gastric velocity was delayed in patients with T1DM compared with controls (p < 0.01). In conclusion, subjects with T1DM do have amylin deficiency but this is not associated with accelerated gastric emptying as we had hypothesized but rather with delayed gastric emptying. Factors other than amylin play a role in control of gastric motility in T1DM. Subcutaneous insulin delivery fails to reach adequate concentrations in the postprandial period to curtail peak glucose concentration in T1DM.

Diabetes Education: the Experiences of Young Adults with Type 1 Diabetes

“…Effective self-management of T1D has evolved to require patients to have an ability to formulate algorithms for insulin replacement dependent upon a complex array of interactive physiological parameters [1]. These parameters include consideration for dietary carbohydrate content and metabolism [2–5], personal glycemic patterns [6, 7], and adjustment for situations such as exercise or sick days [8]. Although tight glycemic control has been shown to delay or prevent the onset of diabetes-related micro-vascular and macro-vascular complications [9–12], the complexity of self-management has meant that the majority of people with T1D fail to maintain recommended levels of glycemic control [13–15].…”

Effect of Pramlintide on Postprandial Glucose Fluxes in Type 1 Diabetes

“…Pramlintide is an analog of islet amyloid polypeptide (IAPP), a hormone cosecreted with insulin by ␤ cells that sends satiety signals to the brain to reduce food intake (7), delays gastric emptying (8), and lowers postprandial plasma glucagon concentrations (9). Though plasma IAPP may be detectable in some patients with T1D, plasma IAPP does not increase after stimulatory testing with either meal ingestion or glucagon (10,11).…”

Physiological and Pathophysiological Role of Islet Amyloid Polypeptide (IAPP, Amylin)

“…However, in a recent study by Heptulla et al, it was hypothesized that accelerated gastric emptying should occur in children with complication-naive type 1 diabetes. Instead they found delayed gastric emptying when compared to controls [90]. Therefore, administration of IAPP in individuals lacking the hormone seems to have a different effect than expected on gastric mobility.…”