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Insulin administration and rate of glucose appearance in people with type 1 diabetes.

Pennant ME, Bluck LJ, Marcovecchio ML, Salgin B, Hovorka R, Dunger DB - Diabetes Care (2008)

Bottom Line: Insulin concentration with prandial insulin was significantly higher than during basal insulin studies (119 +/- 16 vs. 66 +/- 15 pmol/l, P = 0.03 by paired t test).The fraction of the glucose dose appearing in the circulation was the same for basal (73 +/- 8%) and prandial (75 +/- 4%) study days.These results suggest that meal glucose appearance is independent of prandial insulin concentration in people with type 1 diabetes.

View Article: PubMed Central - PubMed

Affiliation: Medical Research Council, Human Nutrition Research, Cambridge, UK. m.pennant@bham.ac.uk

ABSTRACT

Objective: To assess whether prandial insulin, in addition to basal insulin, has an effect on the rate of glucose appearance from a meal in people with type 1 diabetes.

Research design and methods: The rate of glucose appearance from a mixed meal (Ra(meal)) was investigated in six adult (aged 24 +/- 2 years), lean (BMI 23.6 +/- 1.5 kg/m(2)) subjects with well-controlled type 1 diabetes (duration 7.9 +/- 6.9 years, A1C 7.6 +/- 0.9%) with/without prandial insulin. Actrapid was infused to maintain euglycemia before meals were consumed. Subjects consumed two identical meals on separate occasions, and Ra(meal) was measured using a dual isotope method. [6,6-(2)H(2)]glucose was incorporated into the meal (0.081 g/kg body wt), and a primed constant/variable rate infusion of [1,2,3,4,5,6,6-(2)H(2)]glucose was administered. In the tests with prandial insulin, an additional bolus dose of Actrapid was given 20 min before the meal at 0.1 units/kg body wt.

Results: Insulin concentration with prandial insulin was significantly higher than during basal insulin studies (119 +/- 16 vs. 66 +/- 15 pmol/l, P = 0.03 by paired t test). Despite differences in insulin concentration, there were no differences in total glucose appearance (3,398 +/- 197 vs. 3,307 +/- 343 micromol/kg) or time taken for 25% (33.1 +/- 3.3 vs. 31.7 +/- 3.5 min), 50% (54.6 +/- 3.5 vs. 54.1 +/- 4.7 min), and 75% (82.9 +/- 7.1 vs. 82.8 +/- 5.8 min) of total glucose appearance. The fraction of the glucose dose appearing in the circulation was the same for basal (73 +/- 8%) and prandial (75 +/- 4%) study days.

Conclusions: These results suggest that meal glucose appearance is independent of prandial insulin concentration in people with type 1 diabetes.

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Related in: MedlinePlus

Plasma insulin (A) and glucose (B) concentrations following a meal under conditions of basal insulin and with an additional insulin bolus at −20 min.
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f1: Plasma insulin (A) and glucose (B) concentrations following a meal under conditions of basal insulin and with an additional insulin bolus at −20 min.

Mentions: Postprandial glucose, insulin, Rameal, and EGP profiles are presented in Figs. 1 and 2. On prandial compared with basal insulin study days, there were significantly higher AUC insulin and average insulin concentrations, whereas AUC total glucose concentrations were significantly lower (Table 1). There was no difference in total glucose appearance (Table 1), Rameal at any time point (Fig. 2A), or time taken for 25, 50, and 75% of total glucose appearance to take place (Table 1). The fraction of the glucose dose appearing in the circulation was the same under both conditions and was, on average, 75 ± 4% and 73 ± 8% (P = NS) under prandial and basal conditions, respectively. There was no significant difference in total AUC EGP on different study days, but different patterns were evident (Fig. 2B).


Insulin administration and rate of glucose appearance in people with type 1 diabetes.

Pennant ME, Bluck LJ, Marcovecchio ML, Salgin B, Hovorka R, Dunger DB - Diabetes Care (2008)

Plasma insulin (A) and glucose (B) concentrations following a meal under conditions of basal insulin and with an additional insulin bolus at −20 min.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2571071&req=5

f1: Plasma insulin (A) and glucose (B) concentrations following a meal under conditions of basal insulin and with an additional insulin bolus at −20 min.
Mentions: Postprandial glucose, insulin, Rameal, and EGP profiles are presented in Figs. 1 and 2. On prandial compared with basal insulin study days, there were significantly higher AUC insulin and average insulin concentrations, whereas AUC total glucose concentrations were significantly lower (Table 1). There was no difference in total glucose appearance (Table 1), Rameal at any time point (Fig. 2A), or time taken for 25, 50, and 75% of total glucose appearance to take place (Table 1). The fraction of the glucose dose appearing in the circulation was the same under both conditions and was, on average, 75 ± 4% and 73 ± 8% (P = NS) under prandial and basal conditions, respectively. There was no significant difference in total AUC EGP on different study days, but different patterns were evident (Fig. 2B).

Bottom Line: Insulin concentration with prandial insulin was significantly higher than during basal insulin studies (119 +/- 16 vs. 66 +/- 15 pmol/l, P = 0.03 by paired t test).The fraction of the glucose dose appearing in the circulation was the same for basal (73 +/- 8%) and prandial (75 +/- 4%) study days.These results suggest that meal glucose appearance is independent of prandial insulin concentration in people with type 1 diabetes.

View Article: PubMed Central - PubMed

Affiliation: Medical Research Council, Human Nutrition Research, Cambridge, UK. m.pennant@bham.ac.uk

ABSTRACT

Objective: To assess whether prandial insulin, in addition to basal insulin, has an effect on the rate of glucose appearance from a meal in people with type 1 diabetes.

Research design and methods: The rate of glucose appearance from a mixed meal (Ra(meal)) was investigated in six adult (aged 24 +/- 2 years), lean (BMI 23.6 +/- 1.5 kg/m(2)) subjects with well-controlled type 1 diabetes (duration 7.9 +/- 6.9 years, A1C 7.6 +/- 0.9%) with/without prandial insulin. Actrapid was infused to maintain euglycemia before meals were consumed. Subjects consumed two identical meals on separate occasions, and Ra(meal) was measured using a dual isotope method. [6,6-(2)H(2)]glucose was incorporated into the meal (0.081 g/kg body wt), and a primed constant/variable rate infusion of [1,2,3,4,5,6,6-(2)H(2)]glucose was administered. In the tests with prandial insulin, an additional bolus dose of Actrapid was given 20 min before the meal at 0.1 units/kg body wt.

Results: Insulin concentration with prandial insulin was significantly higher than during basal insulin studies (119 +/- 16 vs. 66 +/- 15 pmol/l, P = 0.03 by paired t test). Despite differences in insulin concentration, there were no differences in total glucose appearance (3,398 +/- 197 vs. 3,307 +/- 343 micromol/kg) or time taken for 25% (33.1 +/- 3.3 vs. 31.7 +/- 3.5 min), 50% (54.6 +/- 3.5 vs. 54.1 +/- 4.7 min), and 75% (82.9 +/- 7.1 vs. 82.8 +/- 5.8 min) of total glucose appearance. The fraction of the glucose dose appearing in the circulation was the same for basal (73 +/- 8%) and prandial (75 +/- 4%) study days.

Conclusions: These results suggest that meal glucose appearance is independent of prandial insulin concentration in people with type 1 diabetes.

Show MeSH
Related in: MedlinePlus