Is there a Delay in the Plasma Insulin Response of Patients with Chemical Diabetes Mellitus?

Reaven, Gerald M.; Shen, Shiao-Wei; Silvers, Abraham; Farquhar, John W.

doi:10.2337/diab.20.6.416

Cited by 54 publications

(18 citation statements)

References 16 publications

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“…Perley and Kipnis (2) and Bagdade et al (3) observed a decreased insulin response to glucose in nonobese as well as obese subjects with maturity-onset diabetes when compared with weight-matched controls. On the other hand, Reaven et al (4,5) and other workers (6-8) have reported normal or increased insulin levels in maturity-onset diabetes, thus suggesting a role for insulin resistance in the pathogenesis of this disorder.…”

Section: Introductionmentioning

confidence: 95%

Insulin Sensitivity and Insulin Binding to Monocytes in Maturity-Onset Diabetes

DeFronzo¹,

Deibert²,

Hendler³

et al. 1979

J. Clin. Invest.

185

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A B S T R A C T Tissue sensitive to insulin and insulin binding to monocytes were evaluated in 15 nonobese maturity-onset diabetics and in 16 healthy controls. Insulin sensitivity was determined by the insulin clamp technique in which the plasma insulin is acutely raised and maintained 100 .U/ml above the fasting level and plasma glucose is held constant at fasting levels by a variable glucose infusion. The amount of glucose infused is a measure of overall tissue sensitivity to insulin.In the diabetic group, the fasting plasma glucose concentration (168±4 mg/dl) was 85% greater than controls (P < 0.01) whereas the plasma insulin level (15±1 ,U/ml) was similar to controls. During the insulin clamp study, comparable plasma insulin levels were achieved in the diabetics (118±5) and the controls (114±5 ,uU/ml). However, the glucose infusion rate in the diabetics (4.7±0.4 mg/kg min) was 30% below controls (P < 0.01). Among the diabetics, the glucose infusion rate correlated directly with the fasting plasma glucose level (r = 0.57, P < 0.05). In five diabetic subjects, glucose metabolism was similar to controls, and these diabetics had the highest fasting glucose levels. When they were restudied after prior normalization (with insulin) of the fasting plasma glucose (100±1 mgldl), the glucose infusion rate during the insulin clamp was 30% lower than observed in association with hyperglycemia (P < 0.01). Studies that employed tritiated glucose to measure endogenous glucose production indicated comparable 90-95% inhibition of hepatic glucose production during hyperinsulinemia in the diabetic and control subjects.1251-insulin binding to monocytes in the diabetics (5.5±0.6%) was 30% below that in controls (P < 0.01).

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Section: Introductionmentioning

confidence: 95%

Insulin Sensitivity and Insulin Binding to Monocytes in Maturity-Onset Diabetes

DeFronzo¹,

Deibert²,

Hendler³

et al. 1979

J. Clin. Invest.

185

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“…However, Perley and Kipnis (1967) reported that insulin response to glucose was decreased in diabetic patients in comparison with non-diabetic people from the experiment in which the pattern of blood glucose curves was simulated each other by glucose infusion in diabetes and non-diabetic subjects. To the contrary, Chiles and Tzagournis (1970) and Reaven et al (1971) observed an excessive response of plasma insulin to glucose in mild diabetes. Seltzer et al (1967) reported the delayed hyperinsulinemia in mild diabetics.…”

Section: Discussionmentioning

confidence: 94%

“…Since the fasting level of plasma insulin in diabetes mellitus is not different from that of normal subjects Ohneda 1966), glucose loading has been widely applied by many investigators in the study of the insulin secretion. However, the results are conflicting: Several authors reported the subnormal response of serum insulin to glucose in mild diabetes (Perley and Kipnis 1967;Floyd et al 1968), while others observed an excessive insulin response to glucose (Chiles and Tzagournis 1970;Reaven et al 1971). …”

mentioning

confidence: 99%

Insulin response to tolbutamide-glucose load in normal and diabetic subjects.

Ohneda

Sato

Yamagata

1974

Tohoku J. Exp. Med.

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“…However, at least one extremely important distinction exists between patients with chemical diabetes and those with significant fasting hyperglycemia, and this relates to their insulin response to a glucose challenge. Thus, the insulin response of patients with chemical diabetes is equal to or greater than normal (9)(10)(11)(12)(13). In these patients it seems reasonable to suggest that hyperglycemia is secondary to insulin resistance, and the exaggerated insulin response can be viewed as a compensatory mechanism aimed at minimizing glucose intolerance.…”

Section: Discussionmentioning

confidence: 99%

Demonstration of insulin resistance in untreated adult onset diabetic subjects with fasting hyperglycemia.

Ginsberg¹,

Kimmerling²,

Olefsky³

et al. 1975

J. Clin. Invest.

Self Cite

217

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A B S T R A C T We have used a continuous intravenous infusion of glucose (6 mg/kg/min), insulin (80 mU/ min), epinephrine (6 Ag/min), and propranolol (0.08 mg/min) to directly assess insulin resistance in 14 untreated adult onset diabetics with a mean (±SE) fasting plasma glucose level of 217±17 mg/100 ml. During the infusion endogenous insulin secretion is inhibited and steady-state plasma glucose and insulin levels are achieved after 90 min. Since similar steadystate levels of plasma insulin are achieved in all subjects, the plasma glucose concentration observed during the steady-state period is a measure of an individual's insulin resistance. Under these conditions, the mean (±SE) steady-state plasma glucose level of the 14 diabetic patients was 350±16 mg/100 ml, while that of 12 normal subjects was 121±4 mg/100 ml. Additional studies were performed in which control subjects and patients with diabetes had their fasting plasma glucose levels acutely raised or lowered to comparable levels before receiving the basic infusion mixture of glucose, insulin, epinephrine, and propranolol. The results of these studies indicated that differences in initial plasma glucose levels could not account for the different glucose responses of the two groups to the basic infusion.Finally, the mean (±SE) steady-state plasma glucose level of 104±17 mg/100 ml observed during the same basic infusion in five patients with fasting hyper-

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Is there a Delay in the Plasma Insulin Response of Patients with Chemical Diabetes Mellitus?

Cited by 54 publications

References 16 publications

Insulin Sensitivity and Insulin Binding to Monocytes in Maturity-Onset Diabetes

Insulin Sensitivity and Insulin Binding to Monocytes in Maturity-Onset Diabetes

Insulin response to tolbutamide-glucose load in normal and diabetic subjects.

Demonstration of insulin resistance in untreated adult onset diabetic subjects with fasting hyperglycemia.

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