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Zhang LS, Yu P, Yao F, Lu ZQ, Li XM, Chen H. Insulin autoantibodies, D-dimer and microalbuminuria: A cross-sectional, case-control study of type 2 diabetes. World J Diabetes 2025; 16:101501. [PMID: 39959270 PMCID: PMC11718470 DOI: 10.4239/wjd.v16.i2.101501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 11/10/2024] [Accepted: 12/02/2024] [Indexed: 12/30/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) often leads to vascular complications, such as albuminuria. The role of insulin autoantibodies (IAA) and their interaction with D-dimer in this context remains unclear. AIM To investigate the characteristics of IAA and its effect on albuminuria in T2DM patients. METHODS We retrospectively analyzed clinical data from 115 T2DM patients with positive IAA induced by exogenous insulin, and 115 age- and sex-matched IAA-negative T2DM patients as controls. Propensity scores were calculated using multivariate logistic regression. Key variables were selected using the least absolute shrinkage and selection operator (LASSO) algorithm. We constructed a prediction model and analyzed the association between IAA and albuminuria based on demographic and laboratory parameters. RESULTS The IAA-positive group had significantly higher D-dimer levels [0.30 (0.19-0.55) mg/L vs 0.21 (0.19-0.33) mg/L, P = 0.008] and plasma insulin levels [39.1 (12.0-102.7) μU/mL vs 9.8 (5.5-17.6) μU/mL, P < 0.001] compared to the IAA-negative group. Increases in the insulin dose per weight ratio, diabetes duration, and urinary albumin-to-creatinine ratio (UACR) were observed but did not reach statistical significance. The LASSO model identified plasma insulin and D-dimer as key factors with larger coefficients. D-dimer was significantly associated with UACR in the total and IAA-positive groups but not in the IAA-negative group. The odds ratio for D-dimer elevation (> 0.5 g/L) was 2.88 (95% confidence interval: 1.17-7.07) in the IAA-positive group (P interaction < 0.05). CONCLUSION D-dimer elevation is an independent risk factor for abnormal albuminuria and interacts with IAA in the development of abnormal albuminuria in T2DM patients.
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Affiliation(s)
- Lin-Shan Zhang
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Peng Yu
- Department of Endocrinology, Shanghai Geriatric Medical Center, Shanghai 201104, China
| | - Fei Yao
- Department of Endocrinology, Fuzhou Hospital of Traditional Chinese Medicine, Fuzhou 350000, Fujian Province, China
| | - Zhi-Qiang Lu
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiao-Mu Li
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hong Chen
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Asaka H, Karashima S, Chujo D, Kometani M, Usukura M, Yagi K, Aiga K, Yoneda T. In vivo relationship between bound and free insulin in patients with diabetes having anti-insulin antibodies. Diabetol Int 2023; 14:427-433. [PMID: 37781465 PMCID: PMC10533445 DOI: 10.1007/s13340-023-00641-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/29/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE The Scatchard plot of anti-insulin antibodies is curvilinear, indicating heterogeneity in binding sites. However, the relationship between bound insulin (B) and free insulin (F) in patients with anti-insulin antibodies has not yet been elucidated. This study aimed to determine this relationship. METHODS We studied two insulin-treated patients with diabetes who had high titers of anti-insulin antibodies. The B and F levels were measured using daily blood samples. Assuming that the law of mass action is applicable to the reactions between insulin and anti-insulin antibody forms, we plotted the bound-to-free ratio (B/F) vs. B using patient data. We also performed an equilibrium binding assay in vitro. RESULTS Some of the B/F vs. B plots of the daily variation showed an approximately linear relationship, while the Scatchard plots of in vitro data became curvilinear. CONCLUSION Our study suggests that the one-site (high-affinity site) of anti-insulin antibodies accounts, for the most part, for insulin pharmacokinetics within physiological insulin concentrations. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s13340-023-00641-1.
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Affiliation(s)
- Hiroyuki Asaka
- Division of Endocrine and Diabetes, Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641 Japan
- Daitoku Internal Medicine and Diabetes Clinic, 2-570 Uneda-higashi, Kanazawa, Ishikawa 920-0344 Japan
| | - Shigehiro Karashima
- Institute of Liberal Arts and Science, Kanazawa University, Kanazawa, 920-1192 Japan
| | - Daisuke Chujo
- Center for Clinical Research, Toyama University Hospital, Sugitani 2630, Toyama, 930-0194 Japan
| | - Mitsuhiro Kometani
- Division of Endocrine and Diabetes, Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641 Japan
| | - Mikiya Usukura
- Internal Medicine, Houju Memorial Hospital, 11-71 Midorigaoka, Nomi, Ishikawa 923-1226 Japan
| | - Kunimasa Yagi
- Center for Clinical Genomics, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinada, Ishikawa 920-0293 Japan
| | - Ko Aiga
- Department of Health Promotion and Medicine of the Future, Graduate School of Medicine, Kanazawa University, Kanazawa, 920-8541 Japan
| | - Takashi Yoneda
- Division of Endocrine and Diabetes, Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641 Japan
- Department of Health Promotion and Medicine of the Future, Graduate School of Medicine, Kanazawa University, Kanazawa, 920-8541 Japan
- Faculty of Transdisciplinary Sciences, Institute of Transdisciplinary Sciences, Kanazawa University, Kanazawa, 920-1192 Japan
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Zhou L, Luo Y, Wang Y, Cheng Y, Zhang R, Zhang S, Gong S, Han X, Ji L. The clinical implications of fasting serum insulin levels in patients with insulin-treated type 2 diabetes: a cross-sectional survey. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1172208. [PMID: 37324170 PMCID: PMC10266272 DOI: 10.3389/fcdhc.2023.1172208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023]
Abstract
Objective This study aimed to investigate the clinical implications of fasting serum insulin (FINS) levels in subjects with type 2 diabetes who were receiving insulin therapy. Methods A total of 1,553 subjects with type 2 diabetes [774 subjects who had never received insulin treatment (N-INS) and 779 subjects who were receiving insulin therapy (constant insulin treatment, C-INS)] admitted to the Department of Endocrinology and Metabolism of Peking University People's Hospital were enrolled in this study. Their FINS levels were measured and those with hyperinsulinemia were identified. The underlying mechanisms of hyperinsulinemia were revealed by measuring insulin antibodies (IAs) and analyzing changes in FINS levels before and after polyethylene glycol (PEG) precipitation. In addition, the clinical characteristics of patients with different types of hyperinsulinemia were compared. Results Higher FINS levels and a higher incidence (43.8%, 341/779) of hyperinsulinemia (FINS > 15μIU/mL) were observed in subjects with C-INS than in subjects with N-INS. Among subjects with C-INS and hyperinsulinemia, 66.9% (228/341) were IAs positive, and the incidence of IAs was found to be positively associated with FINS level. By performing PEG precipitation, we found that all subjects without IAs (i.e., those with real hyperinsulinemia) and 31.1% of subjects (71/228) with IAs (i.e., those with both real and IAs-related hyperinsulinemia) still had hyperinsulinemia after PEG precipitation, whereas FINS levels in the other 68.9% of subjects (157/228) with IAs were normal (IAs-related hyperinsulinemia) after PEG precipitation. Comparisons between the groups showed that subjects with real hyperinsulinemia showed more obvious insulin resistance characteristics, including higher lipid levels, BMIs, and homoeostasis model assessment2-estimated insulin resistance (HOMA2-IR) index, and were more likely to have hypertension, obesity, and metabolic syndromes (p < 0.05). However, the risk of hypoglycemia and glucose variability increased significantly in subjects with IAs compared with those without IAs. A cutoff of FINS to serum C-peptide ratio (≥ 9.3μIU/ng) could be used to screen IAs in clinical practice with 83.3% sensitivity and 70% specificity. Conclusions It is necessary to measure FINS in subjects with C-INS to distinguish between types of hyperinsulinemia, which should help to tailor treatment regimens.
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Affiliation(s)
- Lingli Zhou
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Yingying Luo
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Yan Wang
- Department of Endocrinology and Metabolism, People’s Hospital of Deyang City, Deyang, Sichuan, China
| | - Yao Cheng
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Rui Zhang
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Simin Zhang
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Siqian Gong
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Xueyao Han
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
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Liu Y, Ping F, Yu J, Lv L, Zhao Y, Qi M, Li W, Xu L, Yu M, Li M, Zhang H, Li Y. Hypoglycemia Caused by Exogenous Insulin Antibody Syndrome: A Large Single-Center Case Series From China. J Clin Endocrinol Metab 2023; 108:713-717. [PMID: 36219196 DOI: 10.1210/clinem/dgac578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/10/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Exogenous insulin antibody syndrome (EIAS) can lead to unexpected and potentially life-threatening recurrent hypoglycemia. OBJECTIVE We aimed to better define autoimmune hypoglycemia caused by EIAS in patients with diabetes and shed light on the improvements in the identification and intervention for this rare but possibly life-threatening condition. METHODS We summarized the clinical characteristics of autoimmune hypoglycemia caused by EIAS in 23 patients with diabetes. Furthermore, we performed human leukocyte antigen (HLA) genotyping of 10 patients. RESULTS We identified a high frequency of autoimmune comorbidities (21.7%), food or drug allergy (48%), insulin allergy (30%), lipodystrophy at the insulin injection sites (22%), and antinuclear antibodies (25%) in the patients. Alternation between hyperglycemia and hypoglycemia was observed in more than 90% of the patients. Most patients showed a high insulin autoantibody titer (>90%) and inappropriately increased insulin concentration (insulin/C-peptide molar ratio >7, >85%). We detected similar frequencies of DRB1*0405-DQB1*0401 and DRB1*0901-DQB1*0303 compared with previously reported frequencies in type 1 diabetes, and a lower frequency of DRB1*0406 compared with insulin autoimmune syndrome. The spontaneous remission rate exceeded 70%. CONCLUSION Predisposing factors for autoimmune hypoglycemia caused by EIAS include a strong autoimmune background. Susceptible HLA genotypes for type 1 diabetes or insulin autoimmune syndrome might not explain susceptibility to this condition. Additionally, insulin autoantibodies and the insulin/C-peptide molar ratio are reliable screening options. The prognosis for this condition is favorable. Monitoring of insulin and insulin autoantibodies may contribute to treatment effectiveness.
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Affiliation(s)
- Yiwen Liu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Fan Ping
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jie Yu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Lu Lv
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yuan Zhao
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Mengya Qi
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Wei Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Lingling Xu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Miao Yu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ming Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Huabing Zhang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yuxiu Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Liu H, Liang S, Li Y, Fu J, Chen S, Li M, Zhu H, Pan H, Wang O, Yuan T, Mao J, Qin Y, Li Y. A Novel Type of Extreme Insulin Resistance: Nonhypoglycemic Insulin Autoimmune Syndrome. J Clin Endocrinol Metab 2021; 106:1051-1061. [PMID: 33382420 DOI: 10.1210/clinem/dgaa911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Extreme insulin resistance is caused by genetic defects intersecting with the insulin action pathway or by the insulin receptor antibodies. Insulin autoimmune syndrome (IAS) is not considered one of the causes of extreme insulin resistance. OBJECTIVE This work aimed to expand the current knowledge of extreme insulin resistance and to propose the diagnostic criteria and management strategy of a novel type of extreme insulin resistance. METHODS A patient with IAS never experienced hypoglycemia but had persistent hyperglycemia and extreme insulin resistance with treatment with 200 U of intravenous insulin per day. Immunoreactive insulin (IRI), free insulin, and total insulin were measured. The ratio of free insulin to total insulin (insulin-free ratio, IFR) was calculated. RESULTS Extreme insulin resistance has not been reported to be caused by IAS. At admission, IRI and free insulin were undetectable in our patient; total insulin was more than 20 160 pmol/L; and the IFR was lower than 0.03% (control, 90.9%). After adding 500 U porcine insulin to the precipitate containing insulin antibodies, the IRI was still undetectable. Since the patient started glucocorticoid therapy, the free insulin has gradually increased to 11.16 pmol/L, his total insulin has decreased to 5040 pmol/L, and the IFR has increased to 18.26%. Intravenous insulin was stopped, with good glycemic control. CONCLUSION High-affinity insulin autoantibodies with a large capacity can induce a novel type of extreme insulin resistance characterized by extremely high total insulin and very low free insulin levels. The IFR can be used to evaluate therapeutic effects.
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Affiliation(s)
- He Liu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences (PUMCH, CAMS & PUMC), Beijing, China
| | - Siyu Liang
- Eight-year Program of Clinical Medicine, PUMCH, CAMS & PUMC), Beijing, China
| | - Yu Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences (PUMCH, CAMS & PUMC), Beijing, China
| | - Junling Fu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences (PUMCH, CAMS & PUMC), Beijing, China
| | - Shi Chen
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences (PUMCH, CAMS & PUMC), Beijing, China
| | - Ming Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences (PUMCH, CAMS & PUMC), Beijing, China
| | - Huijuan Zhu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences (PUMCH, CAMS & PUMC), Beijing, China
| | - Hui Pan
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences (PUMCH, CAMS & PUMC), Beijing, China
| | - Ou Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences (PUMCH, CAMS & PUMC), Beijing, China
| | - Tao Yuan
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences (PUMCH, CAMS & PUMC), Beijing, China
| | - Jiangfeng Mao
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences (PUMCH, CAMS & PUMC), Beijing, China
| | - Yan Qin
- Department of Nephrology, PUMCH, CAMS & PUMC), Beijing, China
| | - Yuxiu Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Centre, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences (PUMCH, CAMS & PUMC), Beijing, China
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Ward GM, Walters JM, Gooley JL, Boston RC. Adapting Protocols or Models for Use in Insulin-Requiring Diabetes and Islet Transplant Recipients. Front Endocrinol (Lausanne) 2021; 12:611512. [PMID: 34335462 PMCID: PMC8322616 DOI: 10.3389/fendo.2021.611512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
The authors' perspective is described regarding modifications made in their clinic to glucose challenge protocols and mathematical models in order to estimate insulin secretion, insulin sensitivity and glucose effectiveness in patients living with Insulin-Requiring Diabetes and patients who received Pancreatic Islet Transplants to treat Type I diabetes (T1D) with Impaired Awareness of Hypoglycemia. The evolutions are described of protocols and models for use in T1D, and Insulin-Requiring Type 2 Diabetes (T2D) that were the basis for studies in the Islet Recipients. In each group, the need for modifications, and how the protocols and models were adapted is discussed. How the ongoing application of the adaptations is clarifying the Islet pathophysiology in the Islet Transplant Recipients is outlined.
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Affiliation(s)
- Glenn M. Ward
- Department of Endocrinology and Diabetes, St. Vincent’s Hospital, Fitzroy, VIC, Australia
- Department of Clinical Biochemistry, St. Vincent’s Hospital, Fitzroy, VIC, Australia
- University of Melbourne Department of Medicine, St. Vincent’s Hospital, Fitzroy, VIC, Australia
- *Correspondence: Glenn M. Ward,
| | - Jacqueline M. Walters
- Department of Endocrinology and Diabetes, St. Vincent’s Hospital, Fitzroy, VIC, Australia
- University of Melbourne Department of Medicine, St. Vincent’s Hospital, Fitzroy, VIC, Australia
| | - Judith L. Gooley
- Department of Endocrinology and Diabetes, St. Vincent’s Hospital, Fitzroy, VIC, Australia
- University of Melbourne Department of Medicine, St. Vincent’s Hospital, Fitzroy, VIC, Australia
| | - Raymond C. Boston
- Department of Endocrinology and Diabetes, St. Vincent’s Hospital, Fitzroy, VIC, Australia
- University of Melbourne Department of Medicine, St. Vincent’s Hospital, Fitzroy, VIC, Australia
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Januszewski AS, Sachithanandan N, Ward G, Karschimkus CS, O'Neal DN, Jenkins AJ. Estimated insulin sensitivity in Type 1 diabetes adults using clinical and research biomarkers. Diabetes Res Clin Pract 2020; 167:108359. [PMID: 32745699 DOI: 10.1016/j.diabres.2020.108359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/04/2020] [Accepted: 07/28/2020] [Indexed: 01/09/2023]
Abstract
AIMS Insulin resistance in people with type 1 diabetes (T1D) is associated with increased risk of chronic complications and death. The gold standard to quantify insulin sensitivity, a euglycaemic hyperinsulinaemic clamp, is not applicable to clinical practice. We have employed clamp studies to develop a panel of formulae to estimate insulin sensitivity in adults with T1D for use in clinical practice and trials. METHODS Clamps were conducted in 28 adults with T1D, who were also characterised with 38 clinical and research biomarkers. Exhaustive search analysis was used to derive equations correlating with clamp-quantified glucose disposal rate (GDR), GDR/plasma insulin (M/I) and log10M/I. RESULTS Measured insulin sensitivity correlated with BMI, WHR, HDL-C, adipokines and inflammation markers on univariate analysis. Exhaustive search analysis derived three formulae correlating with clamp-derived GDR and logM/I (p < 0.0001), accounting for ≈62% of their variability. A formula using gender, age, HDL-C, pulse pressure and WHR performed as well as those containing inflammation and adipokine measures. CONCLUSIONS The performance of formulae using routinely available parameters with/without research biomarkers in clinical studies and trials, particularly related to future complications, relevant lifestyle interventions, insulin delivery modes and insulin sensitisers is merited.
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Affiliation(s)
- Andrzej S Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, Australia; University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Australia.
| | - Nirupa Sachithanandan
- University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Australia; Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne, Australia
| | - Glenn Ward
- University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Australia; Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne, Australia
| | - Connie S Karschimkus
- University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Australia
| | - David N O'Neal
- University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Australia; Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne, Australia
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Australia; University of Melbourne, Department of Medicine, St. Vincent's Hospital Melbourne, Australia; Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne, Australia
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Sonuga AA, Sonuga OO. Hypovitaminosis D Is Associated with Some Metabolic Indices in Gestational Diabetes Mellitus. Biomed Hub 2020; 5:1177-1190. [PMID: 32884931 PMCID: PMC7443670 DOI: 10.1159/000508207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/25/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM), a pregnancy complication, is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Vitamin D deficiency and insufficiency has recently been recognized as a contributing factor to the pathogenesis of GDM, and this link might be associated with hyperglycemia, insulin resistance, and inflammation, which are implicated in GDM. OBJECTIVES This study aims at investigating the relationship between vitamin D, fasting plasma glucose (FPG), insulin, zinc, ferritin, and high-sensitivity C-reactive protein (CRP) in GDM. METHOD A case-control study in which 80 women attending the antenatal clinic of University College Hospital (UCH), Ibadan, Nigeria, were recruited; the women were grouped into controls (40 nondiabetic pregnant women) and cases (40 pregnant women with GDM). Blood samples were taken at the second trimester, and metabolites were quantified by standard laboratory methods. Student's t test and Pearson correlation were used to compare variables and determine the relationship between variables, respectively. RESULTS Results showed significant (p < 0.05) low levels of serum vitamin D and zinc, and significant (p < 0.05) higher levels of FPG and serum insulin, ferritin, and CRP in the GDM group compared to the control group. In the GDM group, a positive weak relationship was observed between vitamin D and zinc (r = 0.18, p < 0.05), while vitamin D was inversely correlated with FPG, serum insulin, ferritin, and CRP (r = -0.23, -0.21, -0.20, -0.46, respectively, p < 0.05). CONCLUSION This study suggests that hypovitaminosis D might be associated with glucose intolerance, insulin insensitivity, and inflammation, which are factors implicated in the development and progression of GDM.
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Affiliation(s)
- Ayobola Abimbola Sonuga
- Department of Biochemistry, Lead City University, Ibadan, Nigeria
- Chemical Pathology Department, University College Hospital, Ibadan, Nigeria
| | - Oyebola Oluwagbemiga Sonuga
- Department of Biochemistry, Lead City University, Ibadan, Nigeria
- Chemical Pathology Department, University College Hospital, Ibadan, Nigeria
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Zaharieva DP, McGaugh S, Pooni R, Vienneau T, Ly T, Riddell MC. Improved Open-Loop Glucose Control With Basal Insulin Reduction 90 Minutes Before Aerobic Exercise in Patients With Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion. Diabetes Care 2019; 42:824-831. [PMID: 30796112 DOI: 10.2337/dc18-2204] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/29/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To reduce exercise-associated hypoglycemia, individuals with type 1 diabetes on continuous subcutaneous insulin infusion typically perform basal rate reductions (BRRs) and/or carbohydrate feeding, although the timing and amount of BRRs necessary to prevent hypoglycemia are unclear. The goal of this study was to determine if BRRs set 90 min pre-exercise better attenuate hypoglycemia versus pump suspension (PS) at exercise onset. RESEARCH DESIGN AND METHODS Seventeen individuals completed three 60-min treadmill exercise (∼50% of VO2peak) visits in a randomized crossover design. The insulin strategies included 1) PS at exercise onset, 2) 80% BRR set 90 min pre-exercise, and 3) 50% BRR set 90 min pre-exercise. RESULTS Blood glucose level at exercise onset was higher with 50% BRR (191 ± 49 mg/dL) vs. 80% BRR (164 ± 41 mg/dL; P < 0.001) and PS (164 ± 45 mg/dL; P < 0.001). By exercise end, 80% BRR showed the smallest drop (-31 ± 58 mg/dL) vs. 50% BRR (-47 ± 50 mg/dL; P = 0.04) and PS (-67 ± 41 mg/dL; P < 0.001). With PS, 7 out of 17 participants developed hypoglycemia versus 1 out of 17 in both BRR conditions (P < 0.05). Following a standardized meal postexercise, glucose rose with PS and 50% BRR (both P < 0.05), but failed to rise with 80% BRR (P = 0.16). Based on interstitial glucose, overnight mean percent time in range was 83%, 83%, and 78%, and time in hypoglycemia was 2%, 1%, and 5% with 80% BRR, 50% BRR, and PS, respectively (all P > 0.05). CONCLUSIONS Overall, a 50-80% BRR set 90 min pre-exercise improves glucose control and decreases hypoglycemia risk during exercise better than PS at exercise onset, while not compromising the postexercise meal glucose control.
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Affiliation(s)
- Dessi P Zaharieva
- Muscle Health Research Centre, School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Sarah McGaugh
- Muscle Health Research Centre, School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Rubin Pooni
- Muscle Health Research Centre, School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Todd Vienneau
- Insulet Canada Corporation, Oakville, Ontario, Canada
| | - Trang Ly
- Insulet Corporation, Billerica, MA
| | - Michael C Riddell
- Muscle Health Research Centre, School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada .,LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
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10
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Shakil-ur-Rehman S, Karimi H, Gillani SA, Amjad I, Ahmad S, Yaseen A. Response to a Supervised Structured Aerobic Exercise Training Program in Patients with Type 2 Diabetes Mellitus – Does Gender Make a Difference? A Randomized Controlled Clinical Trial. J Natl Med Assoc 2018; 110:431-439. [PMID: 30129517 DOI: 10.1016/j.jnma.2017.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/06/2017] [Accepted: 10/12/2017] [Indexed: 11/28/2022]
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11
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Veiguela Blanco B, Felechosa MD, García Moreira V. Hipoglucemia de causa autoinmune por anticuerpos anti-insulina. Med Clin (Barc) 2018; 150:e43-e44. [DOI: 10.1016/j.medcli.2017.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/07/2017] [Accepted: 10/19/2017] [Indexed: 11/29/2022]
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12
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Campostano A, Altomonte F, Bessarione D, Casu M, Triolo A, Lamedica G. A new Glucose Clamp Algorithm: Clinical Validation. Int J Artif Organs 2018. [DOI: 10.1177/039139889101400711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A. Campostano
- Divisone di Medicina, Ospedale S. Martino, Genova - Italy
| | - F. Altomonte
- Divisone di Medicina, Ospedale S. Martino, Genova - Italy
| | - D. Bessarione
- Divisone di Medicina, Ospedale S. Martino, Genova - Italy
| | - M. Casu
- Divisone di Medicina, Ospedale S. Martino, Genova - Italy
| | - A. Triolo
- Divisone di Medicina, Ospedale S. Martino, Genova - Italy
| | - G. Lamedica
- Divisone di Medicina, Ospedale S. Martino, Genova - Italy
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13
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El-Hak HNG, Moustafa ARA, Mansour SR. Toxic effect of Moringa peregrina seeds on histological and biochemical analyses of adult male Albino rats. Toxicol Rep 2017; 5:38-45. [PMID: 29276689 PMCID: PMC5730415 DOI: 10.1016/j.toxrep.2017.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/19/2017] [Accepted: 12/08/2017] [Indexed: 11/25/2022] Open
Abstract
M. peregrina seeds, taken orally, did not show any alternation in rats’ behavioral signals and no mortality. M. peregrina seeds controlled sugar blood level and lowered hyperlipidaemia by lowering cholesterol and triglyceride levels. M. peregrina seeds, improved liver and kidney functions by lowering liver enzymes and serum creatinine. No histopathological changes were detected in the body tested organs. The intake of different doses of M. peregrina even a high one, exhibit no organ toxicity and are safe for human use.
Moringa is multipurpose promising tree particularly for medicinal use. With its high nutritive and pharmaceutical values, every part of the tree is suitable for human consumptions. The use of vegetate parts, seeds or extracts requires toxicological evaluations to prove and verify safety uses before being added to pharmaceutical medicine, or any other products related to human diet. In this study, Moringa peregrina seeds, grown in high elevation mountain in Saint Catherin area, were investigated and evaluated for their toxicity with respect to its topological potential through histological and biochemical studies in Albino rats. Daily doses of 0, 500, 1000 and 2000 mg/kg body weight of dry seed of M. peregrina were administered orally to 4 groups of rats for 14 days. Biochemical and histopathological results were evaluated by standard methods. Measured biochemical parameters, insulin, albumin, total protein, creatinine, urea, uric acid, Follicle-stimulating hormone, Luteinizing hormone and Testosterone, revealed normal levels compared to control group. However, measured level of blood sugars, cholesterol, triglyceride and liver enzyme, displayed significant decreases. No histopathological changes were detected in the body tested organs. In consequences, intake of different doses of M. peregrina, even high one, exhibit no organ toxicity and are safe for human use.
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Affiliation(s)
- Heba N Gad El-Hak
- Zoology Department, Faculty of Science, Suez Canal University, Ismailia, Egypt
| | | | - Samira R Mansour
- Botany Department, Faculty of science, Suez Canal University, Ismailia, Egypt
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14
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Ashry OM, Hussein EM, Abd El-Azime ASH. Restorative role of persimmon leaf (Diospyros kaki) to gamma irradiation-induced oxidative stress and tissue injury in rats. Int J Radiat Biol 2016; 93:324-329. [DOI: 10.1080/09553002.2016.1254831] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Omaima M. Ashry
- Radiation Biology Department, National Center for Radiation Research and Technology (NCRRT), Atomic Energy Authority (AEA), Cairo, Egypt
| | - Elham M. Hussein
- Radiation Biology Department, National Center for Radiation Research and Technology (NCRRT), Atomic Energy Authority (AEA), Cairo, Egypt
| | - Afrag SH. Abd El-Azime
- Radiation Biology Department, National Center for Radiation Research and Technology (NCRRT), Atomic Energy Authority (AEA), Cairo, Egypt
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15
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McAuley SA, Horsburgh JC, Ward GM, La Gerche A, Gooley JL, Jenkins AJ, MacIsaac RJ, O'Neal DN. Insulin pump basal adjustment for exercise in type 1 diabetes: a randomised crossover study. Diabetologia 2016; 59:1636-44. [PMID: 27168135 DOI: 10.1007/s00125-016-3981-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/29/2016] [Indexed: 01/16/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to investigate the effects of exercise, vs rest, on circulating insulin and glucose, following pre-exercise insulin pump basal rate reduction. METHODS This was an open-label, two-stage randomised crossover study of 14 adults (seven women, seven men) with type 1 diabetes established on insulin pump therapy. In each stage, participants fasted and insulin delivery was halved following a single insulin basal rate overnight. Exercise (30 min moderate-intensity stationary bicycle exercise, starting 60 min post-basal reduction) and rest stages were undertaken in random order at a university hospital. Randomisation was computer-generated, and allocation concealed via sequentially numbered sealed opaque envelopes. Venous blood was collected at 15 min intervals from 60 min pre- until 210 min post-basal rate reduction. Changes in plasma free insulin (the primary outcome), and changes in plasma glucose, with exercise were compared with changes when resting. Outcomes were assessed blinded to group assignment. RESULTS Following basal rate reduction when rested, mean (± SE) free insulin decreased by 4.9 ± 2.9%, 16.2 ± 2.6% and 18.6 ± 3.2% at 1, 2 and 3 h, respectively (p < 0.05 after 75 min). With exercise, relative to rest, mean free insulin increased by 6 ± 2 pmol/l after 15 min and 5 ± 2 pmol/l after 30 min (p < 0.001), then declined post-exercise (p < 0.001). Three participants (mean baseline glucose 5.0 ± 0.1 mmol/l) required glucose supplementation to prevent or treat exercise-related hypoglycaemia. In the other 11 participants (mean baseline glucose 8.4 ± 0.5 mmol/l), glucose increased by 0.8 ± 0.3 mmol/l with exercise (p = 0.028). CONCLUSIONS/INTERPRETATION Halving the basal insulin rate 1 h prior to exercise did not significantly reduce circulating free insulin by exercise commencement. Exercise itself transiently increased insulin levels. In participants with low-normal glucose pre-exercise, hypoglycaemia was not prevented by insulin basal rate reduction alone. Greater insulin basal rate reduction and supplemental carbohydrate may be required to prevent exercise-induced hypoglycaemia. TRIAL REGISTRATION ANZCTR.org.au ACTRN12613000581763 FUNDING: Australian Diabetes Society, Hugh DT Williamson Foundation, Lynne Quayle Charitable Trust Fund.
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Affiliation(s)
- Sybil A McAuley
- Department of Medicine, St Vincent's Hospital, University of Melbourne, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Jodie C Horsburgh
- Department of Medicine, St Vincent's Hospital, University of Melbourne, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia
| | - Glenn M Ward
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Pathology, University of Melbourne, Melbourne, VIC, Australia
| | - André La Gerche
- Department of Medicine, St Vincent's Hospital, University of Melbourne, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Sports Cardiology, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Judith L Gooley
- Department of Medicine, St Vincent's Hospital, University of Melbourne, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia
| | - Alicia J Jenkins
- Department of Medicine, St Vincent's Hospital, University of Melbourne, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Richard J MacIsaac
- Department of Medicine, St Vincent's Hospital, University of Melbourne, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - David N O'Neal
- Department of Medicine, St Vincent's Hospital, University of Melbourne, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia.
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.
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16
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Bisker G, Iverson NM, Ahn J, Strano MS. A pharmacokinetic model of a tissue implantable insulin sensor. Adv Healthc Mater 2015; 4:87-97. [PMID: 25080048 PMCID: PMC6438194 DOI: 10.1002/adhm.201400264] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 06/23/2014] [Indexed: 12/31/2022]
Abstract
While implantable sensors such as the continuous glucose monitoring system have been widely studied, both experimentally and mathematically, relatively little attention has been applied to the potential of insulin sensors. Such sensors can provide feedback control for insulin infusion systems and pumps and provide platforms for the monitoring of other biomarkers in vivo. In this work, the first pharmacokinetic model of an affinity sensor is developed for insulin operating subcutaneously in the limit of where mass transfer across biological membranes reaches a steady state. Using a physiological, compartmental model for glucose, insulin, and glucagon metabolism, the maximum sensor response and its delay time relative to plasma insulin concentration, are calculated based on sensor geometry, placement, and insulin binding parameters for a sensor localized within adipose tissue. A design relation is derived linking sensor dynamics to insulin time lag and placement within human tissue. The model should find utility in understanding dynamic insulin responses and forms the basis of model predictive control algorithms that incorporate sensor dynamics.
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Affiliation(s)
- Gili Bisker
- Department of Chemical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA
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17
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Arzamendi AE, Rajamani U, Jialal I. Pseudoinsulinoma in a white man with autoimmune hypoglycemia due to anti-insulin antibodies: value of the free C-Peptide assay. Am J Clin Pathol 2014; 142:689-93. [PMID: 25319986 DOI: 10.1309/ajcpx56jqbjhubgj] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Insulin autoimmune syndrome (IAS) is an extremely rare cause of hypoglycemia, particularly in non-Asian populations. METHODS In this report, we describe a white male patient with elevated total insulin (>100.0 μIU/mL), C-peptide, and proinsulin levels who was diagnosed with IAS due to anti-insulin antibodies. He also had a small IgG κ M-protein. RESULTS We show that anti-insulin antibodies and/or the monoclonal protein can significantly interfere with insulin and C-peptide immunoassays and propose polyethylene glycol precipitation to quantitate free C-peptide levels as a useful assay in differentiating IAS due to anti-insulin antibodies from insulinoma. CONCLUSIONS In patients presenting with hypoglycemia with excessively high insulin levels, consideration needs to be given to autoimmune hypoglycemia due to anti-insulin antibodies as a cause. Additionally, if total C-peptide levels are increased, free C-peptide needs to be quantitated following polyethylene glycol precipitation.
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Affiliation(s)
- Audrey E. Arzamendi
- Division of Endocrinology, Diabetes, & Metabolism, UC Davis Medical Center, Sacramento, CA
| | - Uthra Rajamani
- Laboratory for Atherosclerosis & Metabolic Research, Departments of Pathology and Internal Medicine, UC Davis Medical Center, Sacramento, CA
| | - Ishwarlal Jialal
- Division of Endocrinology, Diabetes, & Metabolism, UC Davis Medical Center, Sacramento, CA
- Laboratory for Atherosclerosis & Metabolic Research, Departments of Pathology and Internal Medicine, UC Davis Medical Center, Sacramento, CA
- Veterans Affairs Medical Center, Mather, CA
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18
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Weber TH, Käpyaho KI, Tanner P. Endogenous interference in imunoassays in clinical chemistry. A rewiev. Scandinavian Journal of Clinical and Laboratory Investigation 2011. [DOI: 10.1080/00365519009085803] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Thomassen A, Nielsen TT, Bagger JP, Charles P, Løvgreen NA, Sørensen NS. Circadian plasma citrate rhythms in juvenile diabetics. ACTA MEDICA SCANDINAVICA 2009; 210:163-71. [PMID: 7293834 DOI: 10.1111/j.0954-6820.1981.tb09795.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Postabsorptive plasma concentrations of citrate, glucose, lactate, free fatty acids (FFA), ketone bodies and free insulin were measured once weekly for 5 weeks in 18 male juvenile diabetics. The circadian rhythms of the same substances were followed in 12 male diabetics. In 8 of them, daily rhythms were measured twice, before and after plasma glucose was lowered by increasing insulin doses. In the postabsorptive state, the mean plasma citrate concentration of the diabetics, 117 mumol/l (range 65--160), did not differ from that of non-diabetics despite two- to threefold higher levels of plasma glucose, FFA and ketone bodies in diabetics. Daily plasma citrate profile in diabetics showed peak concentrations in the morning and late afternoon. Citrate level throughout the day fell after increased insulin administration, whereas the diurnal pattern remained unchanged. Both the week-to-week coefficient of variation (mean 10%) and the diurnal coefficient of variation (mean 17%) of plasma citrate were below those of any other substances measured (p less than 0.001). Postabsorptive citrate concentration correlated negatively to the diurnal variation of plasma glucose whether diabetic control was apparently good or poor. The results support the idea that plasma citrate level reflects intracellular citrate regulation of glucose utilization. In spite of an interindividual range of 100%, individual citrate level was remarkably constant. Postabsorptive plasma citrate concentration is proposed as a control marker of lability of circulating glucose in insulin-treated diabetics.
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20
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Heding LG, Kasperska-Czyzykowa T. C-peptide and proinsulin after oral glucose. ACTA MEDICA SCANDINAVICA. SUPPLEMENTUM 2009; 639:33-6. [PMID: 6999837 DOI: 10.1111/j.0954-6820.1980.tb12862.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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21
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Kollind M, Adamson U, Lins PE, Curstedt T. Importance of growth hormone for blood glucose regulation following insulin-induced nocturnal hypoglycemia in insulin-dependent diabetes mellitus. ACTA MEDICA SCANDINAVICA 2009; 223:159-64. [PMID: 2894751 DOI: 10.1111/j.0954-6820.1988.tb15781.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The effect of growth hormone (GH) on the glucose homeostasis following nocturnal hypoglycemia was studied between 4 a.m. and noon in eight male patients with insulin-dependent diabetes mellitus (IDDM) by a somatostatin (250 micrograms/h)-insulin (0.4 mU/kg/min)-glucose (6 mg/kg/min)-infusion test (SIGIT). The patients participated in two experiments in which hypoglycemia at 4 a.m. was induced by i.v. insulin (1.5 mU/kg/min). In both experiments the endogenous secretion of GH was suppressed by somatostatin (250 micrograms/h) and glucagon (0.5 ng/kg/min) was given as substitute for the somatostatin-induced suppression of endogenous glucagon secretion. GH (20 mU/kg/h) or saline was given for 60 min from nadir blood glucose in random order. Mean nadir glucose values were the same in both studies (1.7 +/- 0.2 vs. 1.7 +/- 0.1 mmol/l) and no differences were registered in plasma-free insulin, glucagon and the responses of adrenaline and cortisol to hypoglycemia. The infusion of GH resulted in plasma GH levels of about 50 micrograms/l at the end of the infusion, thereafter decreasing to low or immeasurable levels within 2 hours. Infusion of GH evoked a marked hyperglycemia within 4 hours. It is concluded that when hypoglycemia is accompanied by a transient increase in plasma GH, insulin resistance occurs after a lag period of approximately 4 hours and that this effect persists for at least another 4 hours.
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Affiliation(s)
- M Kollind
- Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden
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22
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Lins PE, Clausen N, Adamson U, Kollind M, Hamberger B, Efendic S. Effect of improved glycemic control by continuous subcutaneous insulin infusion on hormonal responses to insulin-induced hypoglycemia in type 1 diabetics. ACTA MEDICA SCANDINAVICA 2009; 218:111-8. [PMID: 4050545 DOI: 10.1111/j.0954-6820.1985.tb08833.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Glucose counter-regulatory capacity and the hormonal responses to insulin-induced hypoglycemia were studied in eight type 1 diabetics before and after improvement of metabolic control by continuous subcutaneous insulin infusion (CSII). The intensified treatment resulted in a decrease in mean glycosylated hemoglobin from 11.6 +/- 0.5 to 9.3 +/- 0.4% within a mean period of 14 weeks. During a constant rate infusion of insulin (2.4 U/h), steady state levels of glucose appeared in all subjects. The steady state glucose level was identical before and after CSII. The counter-regulatory hormonal responses showed significantly higher epinephrine levels, while glucagon, growth hormone, and cortisol were not influenced. In parallel with the heightened epinephrine response the pulse rate response was significantly enhanced. The restitution of blood glucose after insulin hypoglycemia was not modified. It is concluded that a more vigorous catecholaminergic response to hypoglycemia is achieved after improved metabolic control by CSII.
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Sestoft L, Vølund A, Gammeltoft S, Birch K, Hildebrandt P. The Biological Properties of Human Insulin. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.0954-6820.1982.tb03163.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kollind M, Adamson U, Lins PE. Studies of insulin resistance following hypoglycemia in insulin-dependent diabetes mellitus. ACTA MEDICA SCANDINAVICA 2009; 223:153-7. [PMID: 2894750 DOI: 10.1111/j.0954-6820.1988.tb15780.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Insulin resistance was assessed after a hypoglycemia induced by insulin (1.5 mU X kg-1 X min-1) between 7 and 8 a.m. in 10 well-insulinized patients with insulin-dependent diabetes mellitus (IDDM). Blood glucose levels during a somatostatin (100 micrograms X h-1)-insulin (0.4 mU X kg-1 X min-1)-glucose (4.5 mg X kg-1)-infusion test (SIGIT) performed between 11 a.m. and 3 p.m. served as an indicator of total body insulin resistance. Plasma epinephrine, growth hormone, and cortisol increased in response to hypoglycemia, while blunted responses of glucagon were simultaneously registered. At the start of the subsequent SIGIT, blood glucose and plasma-free insulin concentrations were similar to those obtained in the control study without preceding hypoglycemia, and at this point all counter-regulatory hormones had returned to basal. During the SIGIT close to identical levels of plasma-free insulin and counter-regulatory hormones were registered, despite which a significant hyperglycemia was seen 2 hours after the start of the SIGIT when preceded by hypoglycemia. In a separate study, the SIGIT was shown to have a good reproducibility in IDDM patients. We conclude that hypoglycemia evokes a state of insulin resistance for several hours, as demonstrated by elevated blood glucose levels during a somatostatin-insulin-glucose-infusion test.
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Affiliation(s)
- M Kollind
- Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden
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25
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Clausen-Sjöbom N, Lins PE, Adamson U, Curstedt T, Hamberger B. Effects of metoprolol on the counter-regulation and recognition of prolonged hypoglycemia in insulin-dependent diabetics. ACTA MEDICA SCANDINAVICA 2009; 222:57-63. [PMID: 3307308 DOI: 10.1111/j.0954-6820.1987.tb09929.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The effect of metoprolol on the counter-regulation of prolonged hypoglycemia was studied in eight insulin-dependent diabetics. Insulin was given as an i.v. infusion of 2.4 U/h over 180 min alone, or together with metoprolol (3.0 mg i.v. bolus followed by an i.v. infusion of 4.8 mg/h) in random order. Blood glucose, counter-regulatory hormones, hypoglycemic symptoms and the cardiovascular responses were assayed over 240 min. Metoprolol did not significantly modify the blood glucose levels. The plasma levels of free insulin, however, were elevated by approximately 20% (p less than 0.01) by metoprolol during hypoglycemia and the plasma concentrations of epinephrine, norepinephrine, growth hormone and cortisol were enhanced by the drug. Sweating was increased by metoprolol, while other symptoms were unaltered. We conclude that metoprolol administered acutely does not aggravate prolonged hypoglycemia in diabetics with blunted response of glucagon. Moreover, exaggerated responses of counter-regulatory hormones, provoked by metoprolol, may compensate for the inhibitory effect of this drug on insulin clearance.
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26
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Olsson PO, Arnqvist H, von Schenck H. Free insulin profiles in insulin-dependent diabetics treated with one or two insulin injections per day. ACTA MEDICA SCANDINAVICA 2009; 220:133-41. [PMID: 3535391 DOI: 10.1111/j.0954-6820.1986.tb02741.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Twenty-four hour profiles of free insulin and blood glucose were determined in 12 healthy controls and 10 insulin-dependent diabetics treated with insulin regimens based on intermediate-acting insulin injected subcutaneously once or twice a day. The diabetics were ambulatory and in a good glycemic control, i.e. without hyperglycemic symptoms or frequent hypoglycemias and with HbA1 less than 9% (reference value 5.9-7.8%). Body weight was normal and median age (32 years) was the same in both groups. Free insulin was determined after polyethylene glycol precipitation of antibody-bound insulin. The controls had a low basal insulin level (median fasting value 3.9 mU/l) and postprandial peaks with a maximum within 30-60 min. There was no rise in plasma free insulin or blood glucose in the early morning hours. The free insulin profiles in the diabetics were highly unphysiological with hyperinsulinemia between the meals and during the night. The highest plasma free insulin value during the 24 hours was reached before lunch (approximately 5-fold compared to normals, p less than 0.01). Postprandially the free insulin concentrations did not reach the peak levels of the normals. After breakfast, blood glucose rose considerably in the diabetics (p less than 0.02 compared to normals) while the rise after lunch and dinner was not higher than in the healthy controls. The difficulties in glycemic control in the diabetic group, i.e. a blood glucose rise after breakfast and hypoglycemias in some patients, could largely be explained by the unphysiological insulin profiles.
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27
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Nakamura M, Nishida W, Yamada Y, Chujo D, Watanabe Y, Imagawa A, Hanafusa T, Kawasaki E, Onuma H, Osawa H, Makino H. Insulin administration may trigger pancreatic beta-cell destruction in patients with type 2 diabetes. Diabetes Res Clin Pract 2008; 79:220-9. [PMID: 17950950 DOI: 10.1016/j.diabres.2007.08.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 08/27/2007] [Indexed: 11/16/2022]
Abstract
Insulin administration causes various types of immune response to insulin. However, there have been no reports that insulin administration triggers pancreatic beta-cell destruction in diabetic patients. We evaluated three patients who had suffered from type 2 diabetes or impaired glucose tolerance for 5-30 years. After an episode of diabetic mononeuropathy or poor glycemic control, they started human insulin therapy. All the patients' serum or urinary C-peptide levels were preserved before insulin therapy, whereas within a few months they rapidly declined to below detection limits. A high titer of insulin antibody was detected at or after the development of insulin deficiency. Shortly after the initiation of insulin therapy, two of the patients developed an insulin allergy. Autoantibodies to GAD65 or IA-2 were negative throughout the clinical course in two cases, but transiently positive in one case. In a histological examination of pancreas tissue obtained by a pancreatic biopsy in one case, mononuclear cell infiltration into the islets was observed. They all had a type 1 diabetes high-risk HLA class II haplotype in Japanese, and class I alleles of the insulin gene VNTR. The above findings suggest that insulin administration may have triggered pancreatic beta-cell destruction in these patients.
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Affiliation(s)
- Mai Nakamura
- Department of Molecular and Genetic Medicine, Ehime University Graduate School of Medicine, Toon-shi, Ehime 791-0295, Japan
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Kato T, Itoh M, Hanashita J, Itoi T, Matsumoto T, Ono Y, Imamura S, Hayakawa N, Suzuki A, Mizutani Y, Uchigata Y, Oda N. Severe hypoglycaemia in a person with insulin autoimmune syndrome accompanied by insulin receptor anomaly type B. Diabet Med 2007; 24:1279-81. [PMID: 17956452 DOI: 10.1111/j.1464-5491.2007.02232.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS A rare case of the insulin autoimmune syndrome (IAS) accompanied by insulin receptor anomaly is reported. METHODS Antibodies to insulin and insulin receptor were determined in the patient with severe hypoglycaemia before and after the treatment with prednisolone. RESULTS Titers of antibody to insulin and insulin receptors were 73.0% and 41.5%, respectively. Drug-induced lymphocyte stimulation tests were all negative for the suspicious drugs. Her HLA-DR was DRB1*0403/04051. Following steroid therapy, the formation of antibodies was suppressed and alleviated her symptoms. Scatchard analysis yielded findings specific to polyclonal antibodies. CONCLUSIONS The changes in autoantibodies resulted in alleviation of the hypoglycemic symptoms as a result of steroid therapy.
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Affiliation(s)
- T Kato
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Fukita Health University, School of Medicine, Toyoake, Aichi, Japan
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Fineberg SE, Kawabata TT, Finco-Kent D, Fountaine RJ, Finch GL, Krasner AS. Immunological responses to exogenous insulin. Endocr Rev 2007; 28:625-52. [PMID: 17785428 DOI: 10.1210/er.2007-0002] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Regardless of purity and origin, therapeutic insulins continue to be immunogenic in humans. However, severe immunological complications occur rarely, and less severe events affect a small minority of patients. Insulin autoantibodies (IAAs) may be detectable in insulin-naive individuals who have a high likelihood of developing type 1 diabetes or in patients who have had viral disorders, have been treated with various drugs, or have autoimmune disorders or paraneoplastic syndromes. This suggests that under certain circumstances, immune tolerance to insulin can be overcome. Factors that can lead to more or less susceptibility to humoral responses to exogenous insulin include the recipient's immune response genes, age, the presence of sufficient circulating autologous insulin, and the site of insulin delivery. Little proof exists, however, that the development of insulin antibodies (IAs) to exogenous insulin therapy affects integrated glucose control, insulin dose requirements, and incidence of hypoglycemia, or contributes to beta-cell failure or to long-term complications of diabetes. Studies in which pregnant women with diabetes were monitored for glycemic control argue against a connection between IAs and fetal risk. Although studies have shown increased levels of immune complexes in patients with diabetic microangiopathic complications, these immune complexes often do not contain insulin or IAs, and insulin administration does not contribute to their formation. The majority of studies have shown no relationship between IAs and diabetic angiopathic complications, including nephropathy, retinopathy, and neuropathy. With the advent of novel insulin formulations and delivery systems, such as insulin pumps and inhaled insulin, examination of these issues is increasingly relevant.
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Affiliation(s)
- S Edwin Fineberg
- Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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Sumner JM, Valdez F, McNamara JP. Effects of Chromium Propionate on Response to an Intravenous Glucose Tolerance Test in Growing Holstein Heifers. J Dairy Sci 2007; 90:3467-74. [PMID: 17582130 DOI: 10.3168/jds.2006-623] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To test the effect of chromium propionate on glucose utilization in growing dairy heifers, 0, 5, 10, or 15 mg of chromium/d were fed to 20 Holstein heifers of 11 to 14 mo of age, in a replicated Latin square. A 2-wk adaptation period was followed by 4 periods of 2 wk each with a 2-wk flush out period between treatments. Treatments were allotted to periods in a design balanced for potential carryover effects. Chromium propionate was fed in 0.25 kg/d of ground corn individually. After 14 d on each treatment, animals were fitted with an indwelling jugular catheter, and an intravenous glucose tolerance test was conducted the following morning. Body weights increased throughout the experiment, but weights and condition scores were unaffected by treatment. Chromium supplementation increased basal glucose and decreased basal insulin and nonesterified fatty acids (NEFA) in serum in a dose-dependent, quadratic manner. Chromium increased glucose clearance rate as measured by half-life, time to nadir, and area under the curve. Over all periods, insulin concentrations tended to be lower in treated animals whereas clearance rates were unchanged. Serum NEFA levels were negatively correlated with glucose, such that treated animals with increased glucose had lower NEFA overall. There was an apparent long-term effect of chromium, because heifers in period 4 on the control diet had reduced insulin concentrations than those in the other control periods. Chromium propionate may increase glucose utilization in growing dairy heifers.
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Affiliation(s)
- J M Sumner
- Department of Animal Sciences, Washington State University, Pullman 99164-6351, USA
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Basu A, Service FJ, Yu L, Heser D, Ferries LM, Eisenbarth G. Insulin Autoimmunity and Hypoglycemia in Seven White Patients. Endocr Pract 2005; 11:97-103. [PMID: 15901524 DOI: 10.4158/ep.11.2.97] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report the clinical, biochemical, and immunologic characteristics of 7 white patients with the rare disorder of hyperinsulinemic hypoglycemia in association with spontaneously generated high titers of antibodies to human insulin. METHODS We reviewed the clinical data, history, and symptoms of the 7 study patients and summarized the biochemical findings during a spontaneous episode of hypoglycemia. Insulin antibody binding was measured in all patients, and antibody affinity, capacity, and clonality were analyzed in 4. A mixed meal study was conducted in 2 patients. A potential mechanism for postprandial hypoglycemia is presented. RESULTS In all 7 patients (6 women and 1 man), symptoms were neuroglycopenic, occurring primarily postprandially but during fasting in some patients. During hypoglycemia, concentrations of insulin, proinsulin, and, in most patients, C peptide considerably exceeded those observed in patients with insulinoma. These concentrations were spuriously elevated as a result of interference by the autoantibodies in the immunoassays. No patient had evidence of an insulinoma on various radiologic localization procedures directed at the pancreas. Insulin antibodies showed a high percentage of binding to human insulin--50 to 90%. Heterogeneity of antibodies regarding clonality and antibody binding sites was noted; some patients had polyclonal and some had monoclonal IgG class antibodies. Most patients had two categories of binding sites: high affinity/low capacity and low capacity/high affinity. Although the mechanism for postprandial hypoglycemia remains conjectural, prolonged elevations of postprandial concentrations of total and free insulin are consistent with the putative mechanism of a buffering effect of insulin antibodies. CONCLUSION Insulin autoimmune hypoglycemia, although rare in any racial group and especially in white subjects, can be readily detected by high titers of insulin antibodies. Such a determination should be done in all patients undergoing evaluation for hypoglycemia.
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Affiliation(s)
- Ananda Basu
- Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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Enoksson S, Caprio SK, Rife F, Shulman GI, Tamborlane WV, Sherwin RS. Defective activation of skeletal muscle and adipose tissue lipolysis in type 1 diabetes mellitus during hypoglycemia. J Clin Endocrinol Metab 2003; 88:1503-11. [PMID: 12679430 DOI: 10.1210/jc.2002-021013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The increased risk of hypoglycemia during intensified treatment of type 1 diabetes mellitus (T1DM) patients, who have a deficient glucagon secretory response, is largely attributed to the development of suppressed adrenomedullary responses. A consequence of this impairment of catecholamine secretion might be reduced lipolysis in major target tissues (muscle and adipose) and, in turn, increased glucose metabolism. To test this hypothesis, we used microdialysis to monitor glycerol (index of lipolysis) in the extracellular fluid of skeletal muscle and adipose tissue and assessed whole-body glucose use by measuring [6,6-(2)H(2)]glucose enrichment in plasma in seven intensively treated T1DM patients and eight nondiabetic subjects who received a 3-h insulin infusion (0.8 mU/kg.min) on two occasions: during mild-moderate hypoglycemia or euglycemia. In the hypoglycemic study, the rise in plasma epinephrine was approximately 50% less in the T1DM patients despite a greater fall in plasma glucose (to 3.0 vs. 3.5 mM in controls; P < 0.05). Moreover, the rate of glucose flux and the plasma-extracellular fluid glucose gradient in muscle was increased during hypoglycemia in T1DM subjects compared with controls. Glycerol levels in muscle, adipose, and plasma fell similarly in both groups in the first hour. Thereafter, tissue glycerol remained suppressed in the T1DM patients but rebounded significantly (P < 0.01) in the control subjects. The glycerol response in muscle and adipose tissue was significantly correlated with plasma epinephrine concentration (r = 0.73, P = 0.002; and r = 0.52, P = 0.04, respectively), and inversely correlated with whole-body glucose disposal (r = -0.51, P = 0.05; and r = -0.50, P = 0.05). To determine whether the absence of the lipolytic response is limited to deficient catecholamine release, we perfused muscle and adipose tissue in situ with the selective beta(2)-agonist terbutaline during hyperinsulinemic euglycemia. Local addition of agonist increased glycerol and blood flow in both muscle and adipose (P < 0.01 and P < 0.05, respectively) similarly in T1DM and control subjects. We conclude that deficient release of (rather than impaired responsiveness to) catecholamines in T1DM prevents the local fat breakdown within muscle and adipose tissue that normally occurs during mild-moderate hypoglycemia. This defect within peripheral tissues may lead to a delayed increase in glucose disposal that could contribute to the severity of hypoglycemia when it is prolonged.
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Affiliation(s)
- Staffan Enoksson
- Department of Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
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Ruggenenti P, Flores C, Aros C, Ene-Iordache B, Trevisan R, Ottomano C, Remuzzi G. Renal and metabolic effects of insulin lispro in type 2 diabetic subjects with overt nephropathy. Diabetes Care 2003; 26:502-9. [PMID: 12547889 DOI: 10.2337/diacare.26.2.502] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess whether the insulin analog lispro may antagonize the renal effects of IGF-1, a mediator of glomerular hyperfiltration involved in the progression of diabetic and nondiabetic chronic nephropathies. RESEARCH DESIGN AND METHODS In a randomized crossover study, we compared the renal and metabolic responses to regular or lispro insulin (0.1 units/kg body wt) administered after a euglycemic clamp and 5 and 30 min before a standard meal to 11 type 2 diabetic patients with macroalbuminuria. RESULTS Two- and four-hour postprandial changes (vs. preprandial euglycemia) in glomerular filtration rate (GFR) followed a significantly different trend (5.8 +/- 5.0 vs. -6.3 +/- 4.7, P < 0.05; and 11.0 +/- 6.8 vs. 0.7 +/- 5.1%, P < 0.05) after regular insulin and lispro injection, respectively. After lispro, postprandial GFR changes were negatively correlated (r = -0.48, P = 0.0001) with plasma insulin concentration. After regular insulin, renal plasma flow increased in parallel with a decrease in renal vascular resistances. Both changes were fully prevented by lispro. Postprandial blood glucose maximum concentration (278 +/- 16 vs. 240 +/- 16 mg/dl, P < 0.01) and area under the curve (79,381 +/- 19,237 vs. 72,810 +/- 16,211 mg/dl per min, P < 0,05) were significantly lower after insulin lispro than after regular insulin injection, respectively, despite comparable postprandial insulin profiles. Changes in total and gluconeogenic amino acids followed a similar trend. Changes in blood glucose and plasma amino acids did not correlate with concomitant changes in GFR. CONCLUSIONS In overt nephropathy of type 2 diabetes, lispro prevents glomerular hyperfiltration and offsets the renal effects of meal or meal-associated hyperglycemia by mechanisms possibly related to IGF-1 antagonism.
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Affiliation(s)
- Piero Ruggenenti
- Clinical Research Center for Rare Diseases Aldo & Cele Daccò, Ranica, Mario Negri Institute for Pharmacological Research, Bergamo, Italy.
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Halldin MU, Brismar K, Tuvemo T, Gustafsson J. Insulin sensitivity and lipolysis in adolescent girls with poorly controlled type 1 diabetes: effect of anticholinergic treatment. Clin Endocrinol (Oxf) 2002; 57:735-43. [PMID: 12460323 DOI: 10.1046/j.1365-2265.2002.01656.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Increased GH secretion could be one factor behind the impaired glycaemic control often seen in adolescent girls with type 1 diabetes. Because GH induces insulin resistance, treatment with anticholinergic agents, such as pirenzepine (PZP), has been used to reduce GH secretion. However, in a previous study of adolescent girls with type 1 diabetes, we observed an improvement in glycaemic control during 12 weeks of PZP therapy despite unchanged excretion of GH in urine. Considering the complex mechanisms behind urinary GH excretion, the effects of PZP on pituitary GH secretion or secretory pattern cannot be excluded. Thus, to assess the effect of anticholinergic treatment on metabolic control in adolescent girls with diabetes, we have investigated GH secretion, insulin sensitivity and lipolysis before and during treatment with PZP. PATIENTS Eleven adolescent girls with type 1 diabetes and poor metabolic control were investigated before and after treatment with PZP, 100 mg orally, twice a day for 3 weeks. DESIGN Serum samples for analysis of haemoglobin A1c and IGF-I were obtained in addition to serum profiles of GH, insulin and IGFBP-1 before and after 3 weeks of PZP treatment. Effects on insulin sensitivity and lipolysis were also assessed. MEASUREMENTS IGFBP-1 was measured every hour, whereas serum GH and insulin were measured every 20 min for 24 h. Insulin sensitivity was analysed with the hyperinsulinaemic euglycaemic clamp technique. The rate of lipolysis was assessed under basal conditions following a constant rate infusion of [1,1,2,3,3-2H5]-glycerol. In five girls, lipolysis was also estimated during the hyperinsulinaemic euglycaemic clamp. RESULTS There was a significant reduction in haemoglobin A1c levels (9.9 +/- 0.2%vs. 9.1 +/- 0.2; P < 0.0001) during 3 weeks of PZP treatment. In additional, the glucose requirement during the euglycaemic hyperinsulinaemic clamp increased by more than 30% (72.5 +/- 4.9 vs. 96.8 +/- 8.5 mg/m2/min; P = 0.003). However, we could not demonstrate any significant changes in GH secretion (area under the curve, basal levels or peak amplitude) or in the GH secretory pattern (peak height, peak length or interpeak interval). Concordantly, the IGF-I levels were statistically unchanged, as were IGFBP-1 concentrations. The rate of lipolysis did not change under basal conditions (3.40 +/- 0.53 vs. 3.04 +/- 0.54 micro mol/kg/min, n = 11, P = 0.54) or during the hyperinsulinaemic euglycaemic clamp (1.58 +/- 0.21 vs. 2.08 +/- 0.26 micro mol/kg/min; n = 5, P = 0.32). CONCLUSIONS Our observations of an increased glucose requirement during the clamp as well as a decrease in haemoglobin A1c demonstrate improved insulin sensitivity in the adolescent girls with diabetes following pirenzepine therapy. The mechanism behind the improvement is not clear, as neither secretion nor the secretory pattern of GH changed significantly. The persistently high levels of GH might explain the unaltered rate of lipolysis despite the improved insulin sensitivity. The observed improvement in glycaemic control in adolescent girls with type 1 diabetes following pirenzepine therapy is promising, although more studies on this topic are needed.
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Affiliation(s)
- M U Halldin
- Department of Women's and Children's Health, Uppsala University, Sweden.
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Wiggam MI, Hunter SJ, Ennis CN, Sheridan B, Atkinson AB, Bell PM. Insulin action and skeletal muscle blood flow in patients with Type 1 diabetes and microalbuminuria. Diabetes Res Clin Pract 2001; 53:73-83. [PMID: 11403855 DOI: 10.1016/s0168-8227(01)00244-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Our objective was to determine whether Type 1 diabetic patients with microalbuminuria are less sensitive to the effects of insulin on glucose metabolism and skeletal muscle blood flow, compared to those with normal albumin excretion, after careful matching for confounding variables. We recruited 10 normotensive Type 1 diabetic patients with microalbuminuria and 11 with normoalbuminuria matched for age, sex, body mass index, duration of diabetes and HbA(1c). Peripheral and hepatic insulin action was assessed using a two-step euglycaemic hyperinsulinaemic clamp (2 h at 0.4 mU x kg(-1) x min(-1), 2 h at 2.0 mU x kg(-1) x min(-1)) combined with isotope dilution methodology. Skeletal muscle blood flow was determined by venous occlusion plethysmography. During the clamps, glucose infusion rates required to maintain euglycaemia were similar in the microalbuminuric subjects and controls (step 1, 8.2+/-1.4 (SE) vs 9.2+/-1.3 micromol x kg(-1) x min(-1): step 2, 30.9+/-2.7 vs 32.0+/-3.8 micromol x kg(-1) x min(-1)), as was hepatic glucose production basally and at steady state in step 1. In step 2, hepatic glucose production was lower in the microalbuminuric group (2.9+/-0.9 vs 6.4+/-0.7 micromol x kg(-1) x min(-1), P=0.005). During step 2, skeletal muscle blood flow increased significantly above baseline in the normoalbuminuric group (4.1+/-0.5 vs 3.2+/-0.4 ml x 100-ml(-1) x min(-1), P=0.01) but not in the microalbuminuric group (2.4+/-0.3 vs 2.3+/-0.4 ml x 100-ml(-1) x min(-1)). In conclusion, microalbuminuria in Type 1 diabetes was found to be associated with impairment of insulin-mediated skeletal muscle blood flow, but not with insulin resistance.
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Affiliation(s)
- M I Wiggam
- Sir George E. Clark Metabolic Unit, Royal Victoria Hospital, BT12 6BA, Northern Ireland, Belfast, UK
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Martin GJ, Rand JS. Pharmacology of a 40 IU/ml porcine lente insulin preparation in diabetic cats: findings during the first week and after 5 or 9 weeks of therapy. J Feline Med Surg 2001; 3:23-30. [PMID: 11716627 PMCID: PMC10822203 DOI: 10.1053/jfms.2001.0111] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2001] [Indexed: 11/11/2022]
Abstract
The aim of this study was to measure the pharmacokinetics and pharmacodynamics of subcutaneously injected 40 IU/ml porcine lente insulin preparation (Caninsulin, Intervet BV, The Netherlands) in diabetic cats. The pharmacological properties of the insulin in poorly controlled or untreated cats were compared with those after several weeks of treatment, to determine if improved diabetic stability altered the pharmacology of this insulin. In addition, the pharmacological properties of intravenously injected 100 IU/ml regular porcine insulin (Actrapid MC, NovoNordisk, Denmark) were measured. Serial plasma samples were collected after subcutaneous injection of porcine lente insulin from 25 diabetic cats in the first week of admission to a 12-month diabetic treatment trial. Samples were also collected after 4 or 8 weeks of treatment, in those cats which had not achieved diabetic remission by this time. At this time, serial plasma samples were also collected from these cats after intravenous injection of porcine regular insulin. Plasma samples were assayed for glucose, anti-insulin antibodies were extracted using a PEG technique, and samples were assayed for insulin using an RIA kit with low sensitivity for endogenous feline insulin, but high sensitivity for exogenous porcine insulin in feline plasma. Caninsulin injected subcutaneously in diabetic cats led to a peak insulin concentration in plasma after 1.7+/-0.1 h, and a nadir of blood glucose after 4.1+/-0.3 h. Insulin and glucose concentrations returned to baseline within 12 h. There was no significant change in the onset or duration of Caninsulin action between the first week of treatment and 5 or 9 weeks of treatment. Actrapid MC injected intravenously had a peak insulin at 0.36+/-0.03 h, and a nadir of blood glucose at 1.9+/-0.3 h. Insulin and glucose returned to baseline within 6 h. It was concluded that Caninsulin injected subcutaneously has suitable pharmacological properties for the twice-daily treatment of diabetes mellitus in cats. In addition, Actrapid MC insulin injected intravenously has suitable pharmacological properties for injection every 4-6 h in diabetic cats.
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Affiliation(s)
- G J Martin
- Companion Animal Sciences, The University of Queensland, St Lucia, 4072, Australia
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Landstedt-Hallin L, Arner P, Lins PE, Bolinder J, Olsen H, Groop L. The role of sulphonylurea in combination therapy assessed in a trial of sulphonylurea withdrawal. Scandinavian Insulin-Sulphonylurea Study Group Research Team. Diabet Med 1999; 16:827-34. [PMID: 10547209 DOI: 10.1046/j.1464-5491.1999.00171.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To evaluate the effect of adding insulin to sulphonylurea (SU) and the effect of SU withdrawal on glycaemic control in Type 2 diabetic patients who failed on treatment with SU alone. METHOD One hundred and seventy-five patients were included in a placebo-controlled multicentre study. During phase I (4 months), premixed insulin was added to glibenclamide therapy; during phase II (1-4 months, depending on response) the insulin dose was fixed, while placebo or glibenclamide replaced the open SU therapy. Insulin sensitivity (KITT), beta-cell function (C-peptide) and metabolic control (HbA1c) were monitored. RESULTS HbA1c improved from 9.65% to 7.23% (P < 0.0001) during phase I. A high HbA1c value (P < 0.0001) and a high KITT-value (P = 0.045) at baseline were associated with a beneficial response to combination treatment. During phase II, glycaemic control was unchanged in the control (glibenclamide) group. In the placebo group, after SU withdrawal, fasting blood glucose (FBG) increased by 10% or more within 4 weeks in 79% of the patients. Patients (67 of 112) with an FBG increase > or =40% during phase II were defined as 'SU responders' by protocol. In a multivariate analysis only a long duration of diabetes was associated with SU response. There were more GAD-antibody-positive patients among non-responders (18% vs. 4%, P = 0.0263). CONCLUSIONS Poor glycaemic control in combination with preserved insulin sensitivity and lack of GAD antibodies predicts a beneficial response to combination therapy, which can be achieved in 75% of patients with SU failure.
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Affiliation(s)
- L Landstedt-Hallin
- Division of Internal Medicine, Karolinska Institutet Danderyd Hospital, Sweden.
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Halldin MU, Tylleskär K, Hagenäs L, Tuvemo T, Gustafsson J. Is growth hormone hypersecretion in diabetic adolescent girls also a daytime problem? Clin Endocrinol (Oxf) 1998; 48:785-94. [PMID: 9713569 DOI: 10.1046/j.1365-2265.1998.00444.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Glycaemic control often deteriorates during puberty in girls with insulin dependent diabetes mellitus (IDDM). This may be due in part to the normal psychosocial changes associated with adolescence. Puberty is, however, also characterized by rapid somatic development, orchestrated by hormonal changes. Some of these hormones play a major role in glucose homeostasis. We have examined the insulin-GH-IGF-I axis in 11 adolescent girls with poorly controlled insulin dependent diabetes and compared the data with those of 10 non-diabetic girls matched for age, pubertal stage and body mass index (BMI). METHODS Serum profiles of glucose, insulin, GH and IGF binding protein 1 (IGFBP1) were analysed in addition to IGF-I in serum and nocturnal urinary excretion of GH. MEASUREMENTS Serum glucose, insulin and IGFBP1 were measured every hour for 24 h, whereas GH in serum was measured every 30 minutes during the same period. Nocturnal urinary GH was analysed as a mean of three consecutive nights. RESULTS The insulin profiles of the IDDM patients were flat with low post-prandial peaks, corresponding to only one-third of the peaks of the non-diabetic girls. The integrated insulin levels, both during 24-h sampling and during daytime, were significantly lower in the diabetic group. There were no differences during night-time. The diabetic patients had elevated mean baseline levels of serum GH (IDDM 2.8 +/- 0.5 mU/l, controls 0.7 +/- 0.2; P < 0.001), a higher 24-h mean serum GH level (9.8 +/- 1.7 mU/l vs. 4.4 +/- 0.7; P < 0.001), significantly more peaks and a urinary GH excretion twice as high as in the non-diabetic group. An interesting observation was the finding of marked differences in daytime GH concentrations between the groups, both regarding overall integrated levels (GH AUC 103 +/- 15.8 and 35.9 +/- 7.1 mU/l x 12 h, respectively; P < 0.005) as well as baseline levels (3.8 +/- 0.6 mU/l vs. 0.7 +/- 0.2; P < 0.001). In contrast, during night-time only the mean basal levels of GH differed. The level of IGF-I was reduced in the diabetic group compared with the healthy controls (IDDM 233 +/- 19 micrograms/l vs. controls 327 +/- 21; P < 0.005). In addition, the IDDM patients had significantly increased concentrations of IGFBP 1, but kept a normal diurnal rhythm with a pronounced night peak. CONCLUSION Hypoinsulinaemia in adolescent IDDM patients, particularly in the portal hepatic circulation, results in decreased IGF-I and increased IGFBP 1 production in the liver. High levels of IGFBP 1 may, in turn, reduce the bioactivity of IGF-I even further. Low levels of IGF-I will lead to increased GH secretion. Earlier studies on the relationship between GH and diabetic control have focused on elevated GH levels during the night. In this study we have observed markedly elevated levels of GH also during daytime in adolescent IDDM patients. This indicates increased insulin resistance and insulin demand also during the day in diabetic subjects. The increased insulin resistance may result in hyperglycaemia leading to additional insulin resistance. A vicious circle may thus be induced, accelerating metabolic impairment in poorly controlled adolescent IDDM girls.
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Affiliation(s)
- M U Halldin
- Department of Paediatrics, Uppsala University Children's Hospital, Sweden
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La Rocca E, Gobbi C, Ciurlino D, Di Carlo V, Pozza G, Secchi A. Improvement of glucose/insulin metabolism reduces hypertension in insulin-dependent diabetes mellitus recipients of kidney-pancreas transplantation. Transplantation 1998; 65:390-3. [PMID: 9484757 DOI: 10.1097/00007890-199802150-00016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is increasing evidence that metabolic disorders are common in patients with hypertension. To evaluate the relationship between glucose/insulin metabolism and hypertension in diabetes, 61 hypertensive uremic insulin-dependent diabetes mellitus patients who were recipients of kidney or pancreas/kidney transplants were studied through a 1-year follow-up. Twenty of them received a kidney (K) transplant alone, 13 received a kidney and segmental pancreas (KSP), and 28 received a kidney and whole pancreas (KWP) with duodenocystostomy. All subjects received the same immunosuppressive treatment including steroids, azathioprine, and cyclosporine. The three groups of patients were comparable for biochemical parameters, clinical characteristic, cyclosporine levels, and renal function (creatinine < 2 mg/dl). The association between hypertension and type of transplant was evaluated according a global chi-square test, then the results were broken down into two components to test for differences in hypertension between KP versus K and KWP versus KSP groups. The improvement of hypertension rate was statistically associated with KP transplant the first week after surgery, at discharge, and 1 year after transplantation (hypertension% at 1 week: KWP = 75, KSP = 23 vs. K = 70, P = 0.004; at discharge: KWP = 39, KSP = 31 vs. K = 75, P = 0.017; at 1 yr: KWP = 44, KSP = 54 vs. K = 85, P = 0.02). One year after graft fasting, free immunoreactive insulin as well as glycosylated hemoglobin and glucose levels were statistically lower in the KP groups than in the K-alone recipients. The improvement of hypertension observed in KP recipients suggests a key role of glucose and insulin metabolism on pathogenesis of diabetic hypertension.
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Affiliation(s)
- E La Rocca
- Scientific Institute H San Raffaele, University of Milan, Italy
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40
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Kim MR, Sheeler LR, Mansharamani N, Haug MT, Faiman C, Gupta MK. Insulin antibodies and hypoglycemia in diabetic patients. Can a quantitative analysis of antibody binding predict the risk of hypoglycemia? Endocrine 1997; 6:285-91. [PMID: 9368685 DOI: 10.1007/bf02820505] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report a noninsulin-dependent diabetes mellitus (NIDDM) patient with spontaneous, severe hypoglycemic reactions and the presence of insulin antibodies. He had a remote antecedent history of beef-pork insulin therapy as well as exposure to hydralazine. Detailed insulin binding kinetic studies were performed in this patient as well as in six other insulin-treated diabetic patients with anti-insulin antibodies (three with and three without an obvious cause of hypoglycemia). Sera from the current patient and five of the six other diabetic patients (one NIDDM, four IDDM) revealed two types of binding sites: high-affinity with low capacity (Kd, 0.4-12.4 x 10(-9) mol/L; binding capacity, 0.6-659 mU/L) and low-affinity with high capacity (Kd, 0.3 to 35.7 x 10(-7) mol/L; binding capacity; 202-113,680 mU/L). One NIDDM patient had only high-affinity antibodies (Kd, 22.9 x 10(-9) mol/L; binding capacity of 78 mU/L). Type of diabetes mellitus, insulin antibody titers or their binding capacities, insulin levels (total, bound, or free), and bioavailable insulin were not related to hypoglycemic reactions. Two calculated values by the method described tended to discriminate patients with and without hypoglycemia. The calculated amount of low-affinity antibody bound insulin ranged from 69.4-2090 mU/L vs < 4-70.6 mU/L in patients with and without hypoglycemia, respectively. The best discrimination was afford by the percent saturation of low-affinity binding sites; values were clearly higher in the patients with hypoglycemia (2.5-34.4%) than in those without hypoglycemia (not detectable, 0.06, 0.15%). Consideration of the possible drug-associated insulin antibody formation in insulin-treated diabetics and the novel quantitative analysis of the antibody binding kinetics should prove helpful in evaluating patients with high insulin antibody titers and assessing the risk of hypoglycemia.
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Affiliation(s)
- M R Kim
- Department of Endocrinology, Cleveland Clinic Foundation, OH, USA
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41
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Suzuki K, Hirayama S, Ito S. A case of a non-insulin dependent diabetic patient with regular spontaneous hypoglycemic attacks, which were due to insulin-binding antibodies induced by human insulin therapy. TOHOKU J EXP MED 1997; 182:163-73. [PMID: 9261935 DOI: 10.1620/tjem.182.163] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 74-year-old diabetic patient had been treated with oral hypoglycemic agents from the age of 40 years until the age of 72, when his treatment regimen was changed to human insulin. He began experiencing hypoglycemic attacks 14 months after the initiation of insulin therapy. He continued to experience hyperglycemia every morning and hypoglycemia every day at 5:30 p.m. even after insulin therapy was withdrawn. His plasma levels of C-peptide immunoreactivity, total and free immunoreactive insulins were 4.2 ng/ ml, 740 microU/ml and 141.8 microU/ml, respectively. His 125I-insulin binding rate was 94.4%. These findings suggest that his hypoglycemic attacks may have been due to insulin antibodies. Analysis revealed that insulin binding antibodies belonged to IgG with kappa light chains. The patient's genotype was HLA-DR4. He had not received animal insulin or any medications containing a sulfhydryl group. Although the IgG antibody was produced against injected human insulin, his HLA type and the characteristics of his antibodies resembled those of a patient with insulin autoimmune syndrome (IAS). We hypothesize that this patient represented a rare instance of a patient constitutionally similar to a patient with IAS, but whose hypoglycemic attacks resulted from the antibodies induced by the administration of human insulin. This case seems to be the first one with hypoglycemic attacks due to anti-human insulin antibody produced by human insulin therapy.
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Affiliation(s)
- K Suzuki
- Department of Geriatric Medicine, Akita University Hospital, Japan
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42
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Divertie GD, Jensen MD, Cryer PE, Miles JM. Lipolytic responsiveness to epinephrine in nondiabetic and diabetic humans. THE AMERICAN JOURNAL OF PHYSIOLOGY 1997; 272:E1130-5. [PMID: 9227461 DOI: 10.1152/ajpendo.1997.272.6.e1130] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To determine whether the sensitivity of adipose tissue lipolysis to catecholamines is increased in poorly controlled insulin-dependent diabetes, the lipolytic response to epinephrine was measured in seven nondiabetic volunteers and seven poorly controlled diabetic subjects with use of [1-(14)C]palmitate as a tracer. Subjects received sequential 1-h infusions of epinephrine, which produced epinephrine concentrations of approximately 1,000, approximately 1,750, approximately 3,500, and approximately 6,000 pmol/l. A pancreatic clamp was used to maintain constant plasma hormone levels. Concentration-response curves were constructed for each subject from the integrated lipolytic response during each epinephrine infusion. There was no difference in maximal lipolytic response (117 +/- 19 vs. 152 +/- 11 mumol.kg-1.h-1) or in maximally effective (3,171 +/- 267 vs. 3,357 +/- 349 pmol/l) or half-maximally effective (1,081 +/- 109 vs. 1,015 +/- 120 pmol/l) epinephrine concentrations between nondiabetic and diabetic subjects, respectively (all P = NS). In control subjects, maximum beta-hydroxybutyrate concentrations were achieved at lower epinephrine concentrations than those required for a maximum lipolytic effect. Thus, under pancreatic clamp conditions, the lipolytic response to epinephrine in nondiabetic and diabetic subjects was similar.
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Affiliation(s)
- G D Divertie
- Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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Mauras N, Martha PM, Quarmby V, Haymond MW. rhIGF-I administration in humans: differential metabolic effects of bolus vs. continuous subcutaneous delivery. THE AMERICAN JOURNAL OF PHYSIOLOGY 1997; 272:E628-33. [PMID: 9142884 DOI: 10.1152/ajpendo.1997.272.4.e628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The metabolic effects of recombinant human insulin-like growth factor I (rhIGF-I) were compared using bolus vs. continuous subcutaneous infusions. Subjects (n = 5, 29 +/- 3 yr) received rhIGF-I as subcutaneous infusions by a Minimed pump (200 microg x kg(-1) x day(-1) over 16 h/day), and their data were compared with those of subjects (n = 6, 24 +/- 2 yr) who received subcutaneous 200 microg x kg(-1) x day(-1) injections twice a day. L-[1-14C]leucine and [6,6-2H2]glucose infusion studies and indirect calorimetry were performed, and total and free IGF-I, insulin, and glucose concentrations were measured before and after 5-7 days of rhIGF-I. Estimates of protein breakdown, oxidation, and synthesis did not change after pump therapy; in contrast, after bolus doses, protein oxidation decreased (P = 0.001) and whole body protein synthesis increased (P = 0.04). There was no change in lipid oxidation after pump treatment, whereas the bolus group had lower lipid oxidation (P = 0.035). Both treatment modalities increased glucose oxidation (P < 0.02) and glucose production rates (P < 0.03). Overnight fasting insulin concentrations decreased in both groups, whereas plasma glucose remained invariant in the bolus group and decreased modestly in the pump group. Total IGF-I concentrations increased comparably in both groups, but the increase in free IGF-I was greater in the bolus-treated group (P = 0.001). We conclude that, in GH-sufficient postabsorptive individuals, the metabolic effects of rhIGF-I are in part dependent on the mode of administration, with a robust protein-anabolic effect when rhIGF-I is given as twice daily bolus injections but no detectable effect on protein turnover after a continuous mode of delivery. There were higher free IGF-I levels in the bolus-treated subjects, suggesting that this form of the molecule may be important for mediating IGF-I's protein-anabolic effects at the tissue level. The data also suggest that carbohydrate metabolism is more responsive than protein metabolism to the continuous subcutaneous modality of rhIGF-I administration. Even though the mechanism of these differences in metabolic effects is not entirely clear, it should be taken into account when patients are given rhIGF-I as prolonged treatment.
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Affiliation(s)
- N Mauras
- Nemours Children's Clinic, Jacksonville, Florida 32207, USA
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44
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Hoffman RP, Sinkey CA, Anderson EA. Hypoglycemic symptom variation is related to epinephrine and not peripheral muscle sympathetic nerve response. J Diabetes Complications 1997; 11:15-20. [PMID: 9025008 DOI: 10.1016/1056-8727(95)00082-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hypoglycemic unawareness may be due to diminished adrenal and/or peripheral sympathochromaffin responses to hypoglycemia. To determine whether hypoglycemic symptom awareness is more closely related to adrenal or nonadrenal sympathetic activity, we studied the relationship between symptoms and the epinephrine, norepinephrine, and muscle sympathetic nerve activity (MSNA) responses to hypoglycemia in ten IDDM and ten control subjects. MSNA was measured continuously using microneurography during hyperinsulinemic (720 pmol m-2 min-1), glucose clamp with 60 min of euglycemia, 30 min of hypoglycemia, and 30 min of recovery. Subjects were asked to rate a series of symptoms every 10 min during the last 30 min of each period and were unaware of their plasma glucose concentration. MSNA increased significantly in both groups during insulin clamp (p < 0.05) and further increased during hypoglycemia (p < 0.01). Both epinephrine and norepinephrine levels significantly increased during hypoglycemia (p < 0.02). The increase in adrenergic symptom responses during hypoglycemia positively correlated with epinephrine (r = 0.75, p < 0.01), but not with MSNA in the control subjects. A similar near significant relationship for epinephrine was seen in IDDM subjects (r = 0.65, p = 0.056). No significant predictors were found for neuroglycopenic or cholinergic symptoms. Thus, the variation in hypoglycemic symptoms is not related to the MSNA response to hypoglycemia. Adrenergic symptom variation is due to differences in adrenal epinephrine secretion.
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Affiliation(s)
- R P Hoffman
- Department of Pediatrics, University of Iowa College of Medicine, Iowa City, USA
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45
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Linn T, Ortac K, Laube H, Federlin K. Intensive therapy in adult insulin-dependent diabetes mellitus is associated with improved insulin sensitivity and reserve: a randomized, controlled, prospective study over 5 years in newly diagnosed patients. Metabolism 1996; 45:1508-13. [PMID: 8969284 DOI: 10.1016/s0026-0495(96)90180-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Optimal blood glucose levels and normal insulin sensitivity are aims in the treatment of insulin-dependent diabetes mellitus (IDDM). Insulin sensitivity and insulin reserve are closely interrelated. It is essential to know more about both of these parameters at clinical diagnosis, because their preservation may delay the occurrence of diabetes-related complications. B-cell function is likely to be retained for a longer period in patients with adult onset of the disease compared with children. In this study, intensive insulin treatment was initiated in newly diagnosed adult patients to determine if it preserved endogenous insulin secretion longer than conventional therapy. Forty-nine patients with newly diagnosed diabetes were carefully categorized as having IDDM according to clinical and serological criteria. They were randomized to an intensive (I group) or conventional (C group) insulin therapy and evaluated for 5 years. Every 6 months, a check-up included glucagon-stimulated C-peptide (GSCP), hyperglycemic glucose clamp with arginine bolus, euglycemic-hyperinsulinemic clamp, and screening for microalbuminuria, retinopathy, and neuropathy. At the end of the study, hemoglobin A1c (HbA1c) was 6.3% +/- 1.9% in the I patients and 8.1% +/- 2.1% in the C patients (P < .001). Blood glucose concentrations less than 3.5 mmol/L were more frequent in the I group than in the C group (P < .05). Insulin sensitivity (M/I) and GSCP were higher in intensively treated patients after 5 years (M/I, I group 40 +/- 10 nmol x kg(-1) x min(-1) x pmol/L1 v C group 21 +/- 11, P < .005; GSCP, I group 0.6 +/- 0.2 nmol/L v C group 0.19 +/- 0.11, P < .005). The prevalence of peripheral neuropathy was significantly lower in the I group at the end of the study. In conclusion, intensive therapy is more effective in the preservation of insulin action and reserve. In our patients, no case of severe hypoglycemia was observed, indicating that intensive therapy was safe in these patients.
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Affiliation(s)
- T Linn
- Clinical Diabetology and Metabolism Unit, Medical Clinic III, Justus Liebig University, Giessen, Germany
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46
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Linn T, Schneider K, Göke B, Federlin K. Glucagon-like-peptide-1 (7-36) amide improves glucose sensitivity in beta-cells of NOD mice. Acta Diabetol 1996; 33:19-24. [PMID: 8777280 DOI: 10.1007/bf00571935] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The effect of the insulinotropic gut hormone glucagon-like-peptide-1 (GLP-1) was studied on the residual insulin capacity of prediabetic nonobese diabetic (NOD) mice, a model of insulin-dependent diabetes mellitus (type 1). This was done using isolated pancreas perfusion and dynamic islet perifusion. Prediabetes was defined by insulitis and fasting normoglycemia. Insulitis occurred in 100% of NOD mice beyond the age of 12 weeks. K values in the intravenous glucose tolerance test were reduced in 20-week-old NOD mice compared with age matched non-diabetes-prone NOR (nonobese resistant) mice (2.4 +/- 1.1 vs 3.8 +/- 1.5% min-1, P < 0.05). Prediabetic NOD pancreases were characterized by a complete loss of the glucose-induced first-phase insulin release. In perifused NOD islets GLP-1, at concentrations already effective in normal islets, left the insulin release unaltered. However, a significant rise of glucose-dependent insulin secretion occurred for GLP-1 concentrations > 0.1 nM. This was obtained with both techniques, dynamic islet perifusion and isolated pancreas perfusion, indicating a direct effect of GLP-1 on the beta-cell. Analysis of glucose-insulin dose-response curves revealed a marked improvement of glucose sensitivity of the NOD endocrine pancreas in the presence of GLP-1 (half-maximal insulin output without GLP-1 15.2 mM and with GLP-1 9.4 mM, P < 0.002). We conclude that GLP-1 can successfully reverse the glucose sensing defect of islets affected by insulitis.
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Affiliation(s)
- T Linn
- Medical Clinic III and Polyclinic, Justus Liebig University, Giessen, Germany
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47
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Peters A, Klose O, Hefty R, Keck F, Kerner W. The influence of insulin antibodies on the pharmacokinetics of NPH insulin in patients with type 1 diabetes treated with human insulin. Diabet Med 1995; 12:925-30. [PMID: 8846686 DOI: 10.1111/j.1464-5491.1995.tb00398.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The influence of insulin binding antibodies on the pharmacokinetics of NPH insulin was studied in Type 1 diabetic patients on human insulin. Insulin-antibody binding (B(o) was measured during a screening procedure in 155 Type 1 diabetic patients. In 36 patients, B(o) was < 1.5%, and in 38 patients B(o) was > 10.0%. Of these, 6 patients, group 1 (B(o) < 1.5%) and 8 patients, group 2 (B(o) > 10.0%), respectively, subsequently participated in a pharmacokinetic study. Free insulin and the glucose infusion rate were measured using a euglycaemic clamp after subcutaneous injection of NPH insulin (0.4 U kg-1). The areas under the curve (AUC) of free insulin concentration were smaller for group 2 (p = 0.01) than for group 1 (212.2 +/- 22.0 vs 316.8 +/- 25.3 mU l-1h). The AUCs of the glucose infusion rate were also smaller for group 2 (p < 0.05) than for group 1 (2.50 +/- 0.32 vs 3.58 +/- 0.36 g kg-1). A significant negative correlation exists between the AUCs for free insulin concentration and insulin-antibody binding B(o) (r = 0.76, p = 0.001). The daily insulin dosage was higher in group 2 (p = 0.02) than in group 1 (0.66 +/- 0.03 vs 0.53 +/- 0.03 U kg-1). We conclude that insulin antibodies influence the pharmacokinetics of NPH human insulin. The demonstrable influence on the kinetics of free insulin and glucose utilization leads to a slight increase in daily total insulin requirements.
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Affiliation(s)
- A Peters
- Department of Internal Medicine, Medical University of Lübeck, Germany
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48
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Tominaga M, Kimura M, Sugiyama K, Abe T, Igarashi K, Igarashi M, Eguchi H, Sekikawa A, Ogawa A, Manaka H. Effects of seishin-renshi-in and Gymnema sylvestre on insulin resistance in streptozotocin-induced diabetic rats. Diabetes Res Clin Pract 1995; 29:11-7. [PMID: 8593754 DOI: 10.1016/0168-8227(95)01116-u] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Although there is no concept of insulin resistance in traditional Kampo (Chinese) medicine and Indian medicine, we had the hypothesis that some drug in a mixture of crude drugs which was believed to ameliorate diabetes mellitus may have had the effect of improving insulin resistance. To test this hypothesis, the effects of Seishin-renshi-in (Chinese medicine) and Gymnema sylvestre (Indian medicine) on the insulin resistance of streptozotocin-induced diabetic rats was studied by the glucose clamp technique. Oral administration of Seishin-renshi-in (800 mg/kg/day) with injections of a minimum dose of Ultralente insulin decreased urine volume and urinary glucose excretion during a 7-day treatment period and improved the insulin stimulated glucose uptake in peripheral tissues, as well as improving the insulin suppressed hepatic glucose output during glucose clamp. However, G. sylvestre (120 mg/kg/day) treatment did not improve insulin resistance. We conclude that Seishin-renshi-in, with a small dose of insulin, improved insulin resistance in streptozotocin-induced diabetic rats, but Gymnema sylvestre did not.
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Affiliation(s)
- M Tominaga
- Third Department of Internal Medicine, Yamagata University School of Medicine, Japan
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49
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Linn T, Ebener K, Raptis G, Laube H, Federlin K. Natural course of insulin sensitivity and insulin reserve in early insulin-dependent diabetes mellitus. Metabolism 1995; 44:617-23. [PMID: 7752910 DOI: 10.1016/0026-0495(95)90119-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Preservation of endogenous insulin in insulin-dependent diabetes mellitus (IDDM) may prevent the occurrence of diabetes-related complications. Therefore, it is important to known about insulin reserve and insulin sensitivity at clinical manifestation. Twenty-four patients (aged 23 +/- 6 years) were evaluated for 2 years starting at the day of clinical manifestation. Insulin secretion was stimulated by glucagon, arginine, and glucose on separate days. Insulin sensitivity was evaluated by hyperinsulinemic-euglycemic clamp. Two control groups were established, one consisting of age-, weight-, and sex-matched healthy individuals, the other of patients with diabetes of long duration (6 to 13 years). Sensitivity improved from 30% of normal at baseline to 84% after only 2 weeks in the newly manifested patients. Subsequently, insulin released by nonglucose stimuli increased by 75%. Glucose-induced first-phase insulin secretion did not recover. After 2 years, sensitivity was 20% less than normal and glucagon-stimulated C-peptide (GSCP) was 0.64 +/- 0.20 nmol/L (0.41 +/- 0.19 at baseline, P < .002). Insulin sensitivities in euglycemic and hyperglycemic conditions were closely correlated. In conclusion, improvement of insulin sensitivity precedes and is possibly a prerequisite for the recovery of residual insulin in early IDDM.
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Affiliation(s)
- T Linn
- Clinical Diabetology and Metabolism Unit, Medical Clinic III, Justus Liebig University, Giessen, Germany
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50
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La Rocca E, Secchi A, Parlavecchia M, Bonfatti D, Ragogna F, Di Carlo V, Pozza G, Ruotolo G. Lipoprotein profile after combined kidney-pancreas transplantation in insulin dependent diabetes mellitus. Transpl Int 1995; 8:190-5. [PMID: 7626178 DOI: 10.1007/bf00336536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In order to evaluate the effect of a combined kidney-pancreas (KP) transplantation in insulin-dependent diabetes mellitus (IDDM) patients on the lipid and lipoprotein profile, 15 KP patients were compared with 11 kidney (K)--transplanted IDDM patients, 19 IDDM patients on hemodialysis (HD), and 15 nondiabetic control subjects. Cholesterol, triglycerides, apo AI, and apo B were measured in total plasma and in VLDL, LDL, and HDL of all participants. VLDL cholesterol, VLDL-triglycerides, and VLDL-apo B were significantly lower in KP patients, but not in K patients, than in HD patients. In addition, patients in the K, but not in the KP, group showed high levels of apo B in LDL and an increased triglyceride/apo B ratio in VLDL, compared with patients in the HD group. The percentage of apo AI associated with HDL was significantly higher in both transplanted groups than in the HD group. However, compared with a nondiabetic control population, an increase in VLDL particles and in triglyceride content in LDL and HDL still persisted following combined KP transplantation. Insulin resistance (probably due to steroid therapy) associated with high peripheral and potentially low hepatic insulin levels (due to the systemic drainage of the transplanted pancreas) could be the main causes of the remaining lipoprotein abnormalities.
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Affiliation(s)
- E La Rocca
- Department of Medicine, Scientific Institute H San Raffaele, Milan, Italy
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