Natural course of insulin sensitivity and insulin reserve in early insulin-dependent diabetes mellitus.
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.
Linn
T
T
Clinical Diabetology and Metabolism Unit, Medical Clinic III, Justus Liebig University, Giessen, Germany.
Ebener
K
K
Raptis
G
G
Laube
H
H
Federlin
K
K
D000328:Adult; D001120:Arginine; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood*; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000503:physiopathology; D005260:Female; D005934:Glucagon; D015309:Glucose Clamp Technique; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000097:blood / Q000378:metabolism*; D000078790:Insulin Secretion; D007515:Islets of Langerhans / Q000187:drug effects / Q000378:metabolism*; D008137:Longitudinal Studies; D008297:Male; D012016:Reference Values; D012044:Regression Analysis; D013997:Time Factors
D001120:Arginine; D001786:Blood Glucose; D002096:C-Peptide; D005934:Glucagon; D006442:Glycated Hemoglobin; D007328:Insulin