Abnormal meal carbohydrate disposition in insulin-dependent diabetes. Relative contributions of endogenous glucose production and initial splanchnic uptake and effect of intensive insulin therapy.
Open Access
- 1 September 1984
- journal article
- research article
- Published by American Society for Clinical Investigation in JCI Insight
- Vol. 74 (3), 985-991
- https://doi.org/10.1172/jci111519
Abstract
Postprandial hyperglycemia in insulin-deficient, insulin-dependent diabetic subjects may result from impaired suppression of endogenous glucose production and/or abnormal disposition of meal-derived glucose. To investigate the relative contributions of these processes and to determine whether 2 wk of near normoglycemia achieved by using intensive insulin therapy could restore the pattern of glucose disposal to normal, meal-related and endogenous rates of glucose appearance were measured isotopically after ingestion of a mixed meal that contained deuterated glucose in seven lean insulin-dependent and five lean nondiabetic subjects. Diabetic subjects were studied once when insulin deficient and again during intensive insulin therapy after 2 wk of near normoglycemia. Total glucose production was determined by using tritiated glucose and the contribution of meal-related glucose was determined by using the plasma enrichment of deuterated glucose. The elevated basal and peak postprandial plasma glucose concentrations (252 +/- 33 and 452 +/- 31 mg/dl) of diabetic subjects when insulin deficient were decreased by intensive insulin therapy to values (82 +/- 6 and 193 +/- 10 mg/dl, P less than 0.01) that approximated those of nondiabetic subjects (93 +/- 3 and 140 +/- 15 mg/dl, respectively). Total and endogenous rates of glucose appearance (3,091 +/- 523 and 1,814 +/- 474 mg/kg per 8 h) in the diabetic subjects were significantly (P less than 0.02) greater than those in non-diabetic subjects (1,718 +/- 34 and 620 +/- 98 mg/kg per 8 h, respectively), whereas meal-derived rates of glucose appearance did not differ. Intensive insulin therapy decreased (P less than 0.01) both total (1,581 +/- 98 mg/kg per 8 h) and endogenous (478 +/- 67 mg/kg per 8 h) glucose appearance to rates that approximated those observed in the nondiabetic subjects, but did not alter meal-related glucose appearance. Thus, excessive entry of glucose into the peripheral circulation in insulin-deficient diabetic patients after ingestion of a mixed meal resulted from a lack of appropriate suppression of endogenous glucose production rather than impairment of initial splanchnic glucose uptake. Intensive insulin therapy restored postprandial suppression of endogenous glucose production to rates observed in nondiabetic subjects.Keywords
This publication has 25 references indexed in Scilit:
- Influence of Oral Glucose Ingestion on Splanchnic Glucose and Gluconeogenic Substrate Metabolism in ManDiabetes, 1975
- Glucose Kinetics During Oral Glucose Tolerance Test in Normal, Methylprednisolone-Treated and Alloxan Diabetic DogsDiabetes, 1974
- Estimation of Hepatic Glucose Output in Non-Steady State. The Simultaneous Use of 2-3H-glucose and 14C-glucose in the DogCanadian Journal of Physiology and Pharmacology, 1974
- Effects of insulin on gluconeogenesis and cyclic AMP levels in perfused livers from diabetic ratsBiochimica et Biophysica Acta (BBA) - General Subjects, 1973
- A Simple Method for the Determination of Serum Free Insulin Levels in Insulin-treated PatientsDiabetes, 1973
- Forearm Glucose Uptake During the Oral Glucose Tolerance Test in Normal SubjectsDiabetes, 1973
- Influence of Endogenous Insulin Secretion on Splanchnic Glucose and Amino Acid Metabolism in ManJCI Insight, 1971
- Mean Amplitude of Glycemic Excursions, a Measure of Diabetic InstabilityDiabetes, 1970
- Glucose-2-t as a Tracer for Glucose Metabolism*Biochemistry, 1967
- ON THE HORMONAL REGULATION OF CARBOHYDRATE METABOLISM - STUDIES WITH C-14 GLUCOSE1963