Natural course of insulin sensitivity and insulin reserve in early insulin-dependent diabetes mellitus

Metabolism. 1995 May;44(5):617-23. doi: 10.1016/0026-0495(95)90119-1.

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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Arginine
  • Blood Glucose / metabolism*
  • C-Peptide / blood*
  • Case-Control Studies
  • Diabetes Mellitus, Type 1 / blood*
  • Diabetes Mellitus, Type 1 / physiopathology
  • Female
  • Glucagon
  • Glucose Clamp Technique
  • Glycated Hemoglobin A / analysis
  • Humans
  • Insulin / blood
  • Insulin / metabolism*
  • Insulin Secretion
  • Islets of Langerhans / drug effects
  • Islets of Langerhans / metabolism*
  • Longitudinal Studies
  • Male
  • Reference Values
  • Regression Analysis
  • Time Factors

Substances

  • Blood Glucose
  • C-Peptide
  • Glycated Hemoglobin A
  • Insulin
  • Glucagon
  • Arginine