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.
Diabetes Research Group and Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
Ana
A
Jovanovic
Jean
J
Gerrard
Roy
R
Taylor
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