Insulin infusion normalizes fasting and post-prandial albumin and fibrinogen synthesis in Type 1 diabetes mellitus.
OBJECTIVE
The effect of metabolic control on hepatic synthesis of plasma proteins in Type 1 diabetes mellitus (T1DM), in the post-absorptive and post-prandial state, is not known.


METHODS
We measured fractional synthetic rates (FSR) of albumin and fibrinogen in six insulin-infused T1DM patients and in five to nine control subjects, before and for approx. 4 h after a mixed liquid meal. Phenylalanine tracer precursor/product relationships and steady-state conditions were used. In the post-absorptive state, patients were studied in near euglycaemic conditions after an overnight intravenous insulin infusion. During the meal (approx. 11 kcal/kg), the insulin infusion rate was increased to maintain plasma glucose concentrations below approx. 10 mmol/l.


RESULTS
Post-absorptive FSR of albumin (5.7 +/- 0.6%/day) and fibrinogen (11.3 +/- 0.6%/day) in T1DM were similar to control values (6.4 +/- 0.9 and 13.1 +/- 1.1, respectively). After the meal, albumin FSR increased (P = 0.0032 by anova) in both groups (T1DM, to 14.4 +/- 2.7%/day; controls, to 18.2 +/- 3.7%/day). Fibrinogen FSR also increased (P = 0.0048 by anova) in both the T1DM (to 18.2 +/- 2.6) and the control subjects (to 27.3 +/- 6.2). There was no difference between T1DM and control subjects in the post-prandial FSR of both proteins.


CONCLUSIONS
Albumin and fibrinogen FSR in T1DM can be maintained within near-normal ranges by insulin infusion under post-absorptive and post-prandial conditions.
Bruttomesso
D
D
Department of Clinical and Experimental Medicine, Chair of Metabolism, University of Padova, Padova, Italy.
Iori
E
E
Kiwanuka
E
E
Zanetti
M
M
Pianta
A
A
Vettore
M
M
Tiengo
A
A
Tessari
P
P
D000328:Adult; D000596:Amino Acids / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D005215:Fasting; D005260:Female; D005340:Fibrinogen / Q000096:biosynthesis*; D005502:Food; D005934:Glucagon / Q000097:blood; D006801:Humans; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D007700:Kinetics; D008297:Male; D010649:Phenylalanine / Q000008:administration & dosage / Q000097:blood; D012709:Serum Albumin / Q000096:biosynthesis*; D014316:Tritium
D000596:Amino Acids; D001786:Blood Glucose; D007328:Insulin; D012709:Serum Albumin; D014316:Tritium; D010649:Phenylalanine; D005340:Fibrinogen; D005934:Glucagon