The second-meal phenomenon in type 2 diabetes.
OBJECTIVE
In health, the rise in glucose after lunch is less if breakfast is eaten. We evaluated the second-meal effect in type 2 diabetes.


METHODS
Metabolic changes after lunch in eight obese type 2 diabetic subjects were compared on 3 days: breakfast eaten, no breakfast, and no breakfast but intravenous arginine 1 h before lunch.


RESULTS
Despite comparable insulin levels, the rise in plasma glucose after lunch was considerably less if breakfast had been eaten (0.68 +/- 1.49 vs. 12.32 +/- 1.73 vs. 7.88 +/- 1.03 mmol x h(-1) x l(-1); P < 0.0001). Arginine administration almost halved the lunch rise in plasma glucose (12.32 +/- 1.73 vs. 7.88 +/- 1.03 mmol x h(-1) x l(-1)). The plasma free fatty acid concentration at lunchtime directly related to plasma glucose rise after lunch (r = 0.67, P = 0.0005).


CONCLUSIONS
The second-meal effect is preserved in type 2 diabetes. Premeal administration of a nonglucose insulin secretagogue results in halving the postprandial glucose rise and has therapeutic potential.
Jovanovic
Ana
A
Diabetes Research Group and Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
Gerrard
Jean
J
Taylor
Roy
R
D001120:Arginine / Q000494:pharmacology; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000378:metabolism; D002395:Catecholamines / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology / Q000523:psychology*; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005247:Feeding Behavior / Q000502:physiology*; D005934:Glucagon / Q000097:blood; D006801:Humans; D007328:Insulin / Q000097:blood; D019518:Postprandial Period
D001786:Blood Glucose; D002096:C-Peptide; D002395:Catecholamines; D005230:Fatty Acids, Nonesterified; D007328:Insulin; D005934:Glucagon; D001120:Arginine