Serum Insulin Levels Following Administration of Exogenous Insulin

Ginsberg, Sandra J.; Block, Martin Paul; Mako, Mary E.; Rubenstein, Arthur H.

doi:10.1210/jcem-36-6-1175

Cited by 32 publications

(17 citation statements)

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“…Whether insulin levels in this setting are a risk factor for CHD has not been determined. Exogenous insulin therapy may result in high serum insulin levels (6,7). In the present observational study, we examine the relationship of serum insulin levels with incident CHD in an insulin-treated diabetic cohort.…”

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confidence: 99%

The Relationship of Fasting Serum Radioimmune Insulin Levels to Incident Coronary Heart Disease in an Insulin-Treated Diabetic Cohort

Kronmal

Barzilay

Tracy

et al. 2004

The Journal of Clinical Endocrinology &Amp; Metabolism

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It is not known whether insulin levels, in the setting of insulin treatment, are an independent risk factor for coronary heart disease (CHD). We studied a cohort of 116 insulin-treated individuals, 65 yr or older, who were followed for 5.6-9 yr. All were free of CHD at baseline. There were 47 incident CHD events. In Cox proportional hazards modeling, with fasting immune-reactive insulin levels as a continuous variable, the hazard ratio for CHD was statistically significant (P < 0.0001). When insulin levels were divided into intervals, those in the third interval [43-150 microU/ml (258-900 pmol/liter)] had an adjusted 30% increased relative risk (95% confidence interval, 0.57, 2.98) compared with those in the first interval [<20 microU/ml (<120 pmol/liter)]. Those in the fourth interval [151-400 microU/ml (906-2400 pmol/liter)] had an adjusted 5.6-fold increased risk (2.3-13.1; P < 0.0001). Approximately 15% of the cohort had such elevated insulin levels. Immune-reactive insulin levels were strongly correlated with specific insulin, proinsulin, and insulin antibody levels. Markedly elevated fasting immune-reactive insulin levels were an independent risk factor for CHD in this study of insulin-treated older adults. These observational findings should be confirmed through larger prospective studies, given their implications for insulin therapy.

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confidence: 99%

The Relationship of Fasting Serum Radioimmune Insulin Levels to Incident Coronary Heart Disease in an Insulin-Treated Diabetic Cohort

Kronmal

Barzilay

Tracy

et al. 2004

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…creatinine. 18 This observation was proposed to reflect the difference between basal insulin secretion during a nighttime period of relative fasting and the higher levels that result from dietary stimuli. 18 The rather constant amounts of insulin excreted throughout the day by the normal children described herein suggest that, in contrast to adults, certain nocturnal stimuli modulate insulin secretion in children.…”

Section: Discussionmentioning

confidence: 99%

“…18 This observation was proposed to reflect the difference between basal insulin secretion during a nighttime period of relative fasting and the higher levels that result from dietary stimuli. 18 The rather constant amounts of insulin excreted throughout the day by the normal children described herein suggest that, in contrast to adults, certain nocturnal stimuli modulate insulin secretion in children. This is an important consideration in the management of children with diabetes mellitus, as nocturnal insulin secretion may be uniquely physiologic for children and important for the rapid growth that occurs during this stage of development.…”

Section: Discussionmentioning

confidence: 99%

Renal Wastage of Insulin in Children with Diabetes Mellitus

Malone

Root

1976

Diabetes

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In normal human beings the percentage of serum insulin excreted in the urine is constant over a wide range of values. The quantity of immunoreactive insulin found in the urine is believed to reflect the level of free insulin in the serum. Immunoreactive insulin was measured in the urine of nondiabetic children and diabetic children receiving exogenous insulin. Children with diabetes mellitus excreted greater amounts of immunoreactive insulin (18.5+/-8 muU./mg. creatinine) than did nondiabetic children (11.9+/-5 muU./mg. creatinine). This difference was statistically significant (p less than 0.0005). Children with "poor glycemic control" excreted a greater portion of their administered insulin dose than did those with "good control." The renal wastage of insulin correlated (r=0.94) with the duration of insulin treatment but not with the quantity administered. Antibody binding of serum insulin may explain in part these observations, but an acquired defect in the renal tubular reabsorption of insulin may also exist. Modifications in the management of diabetes that reduce the renal wastage of insulin may improve the metabolic stability of children with "poor diabetic control."

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“…There¬ after, the total insulin continued to rise to much greater concentrations, most of it being antibody bound. The free insulin concentrations not only reached the same maximum as after injection of about half that amount in non-diabetics (Galloway et al 1973;Ginsberg et al 1973), but the rate of increase was slower. In non-diabetic subjects the 2 h values are greater than those found after 4 h (Galloway et al 1973;Ginsberg et al 1973), while the reverse was seen in our patients.…”

Section: Subcutaneous Insulinmentioning

confidence: 98%

“…The free insulin concentrations not only reached the same maximum as after injection of about half that amount in non-diabetics (Galloway et al 1973;Ginsberg et al 1973), but the rate of increase was slower. In non-diabetic subjects the 2 h values are greater than those found after 4 h (Galloway et al 1973;Ginsberg et al 1973), while the reverse was seen in our patients. However, the insulin rises were similar for the 2 patient groups suggesting that differences in daily insulin doses cannot be explained in terms of insulin passage from the injection site into the circulation.…”

Section: Subcutaneous Insulinmentioning

confidence: 98%

The role of insulin absorption and sensitivity in determining a diabetic's daily insulin dosage

Asplin¹,

Hartog²,

Goldie³

et al. 1980

Acta Endocrinologica

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The change of serum free and total insulin, and of blood intermediary metabolites, growth hormone and cortisol have been determined after separate tests using 0.3 units/kg 'Actrapid MC' given by sc injection and 0.04 units/kg/h by iv infusion in 16 fasted chronic-bovine-insulin-treated diabetics. Eight of these diabetics normally received 32 units or less of conventional, mainly bovine insulin a day and the other eight 128 units or more. Paradoxically the high dose group had a greater fall (5.6 V 3.1 mmol/l; P < 0.05) in blood glucose four h after the sc insulin injection despite similar pre-insulin values (8.2 and 6.9 mmol/l respectively). Otherwise the responses were markedly similar in the two groups to both sc and iv insulin. Thus the gross differences in daily insulin dosage could not be explained in terms of insulin absorption or sensitivity as assessed by several metabolic parameters.Factors which determine a diabetic's daily insulin dosage are poorly understood (Asplin et al. 1978a), low insulin dosage often, but not always being associated with endogenous insulin secretion (Asp¬ lin et al. 1978a;Eff et al. 1978). The injection of insulin is followed by changes in several interme¬ diary blood metabolites, reflecting the action of this hormone on carbohydrate, fat and protein metabo¬ lism, also the secretion of several counter-regula¬ tory hormones may be stimulated. By following changes in circulating concentrations of the coun¬ ter-regulatory hormones, insulin and metabolites following sc or iv injection of insulin it should be possible to determine if differences in daily insulin dosage can be determined by differences in insulin absorption into the circulation or by differences in its effect once there. The almost universal presence of anti-insulin antibodies in chronic bovine insulin treated diabetics (Berson & Yalow 1964) means that circulating insulin is in bound and free forms, the anti-insulin antibodies perhaps having a buf¬ fering effect (Dixon et al. 1975). In the present study we compare the circulating metabolite and insulin responses to injected insulin in eight longterm insulin-dependent diabetics on low daily doses of insulin with those of eight patients on high insulin doses. The present study is an extension of the one reported by us (Asplin et al. 1978a), comparing the diurnal profiles of circulating insu¬ lin and intermediary metabolites. Patients and MethodsSixteen patients were studied, eight with low (< 32 units) and eight with high (> 128 units) daily insulin dosage that had been stable for at least 9 months. Details of the 2

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Serum Insulin Levels Following Administration of Exogenous Insulin

Cited by 32 publications

References 0 publications

The Relationship of Fasting Serum Radioimmune Insulin Levels to Incident Coronary Heart Disease in an Insulin-Treated Diabetic Cohort

The Relationship of Fasting Serum Radioimmune Insulin Levels to Incident Coronary Heart Disease in an Insulin-Treated Diabetic Cohort

Renal Wastage of Insulin in Children with Diabetes Mellitus

The role of insulin absorption and sensitivity in determining a diabetic's daily insulin dosage

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