Insulin Administration and Rate of Glucose Appearance in People With Type 1 Diabetes
- Mary E. Pennant, PHD12,
- Leslie J.C. Bluck, D PHIL1,
- M. Loredana Marcovecchio, M MD3,
- Burak Salgin, MB, BCHIR3,
- Roman Hovorka, PHD3 and
- David B. Dunger, MBBS, MD, FRCP3
- 1Medical Research Council, Human Nutrition Research, Cambridge, U.K.
- 2Department of Public Health, University of Birmingham, Birmingham, U.K.
- 3Department of Pediatrics, University of Cambridge, Cambridge, U.K.
- Corresponding author: Mary Pennant, m.pennant{at}bham.ac.uk
Abstract
OBJECTIVE—To assess whether prandial insulin, in addition to basal insulin, has an effect on the rate of glucose appearance from a meal in people with type 1 diabetes.
RESEARCH DESIGN AND METHODS—The rate of glucose appearance from a mixed meal (Rameal) was investigated in six adult (aged 24 ± 2 years), lean (BMI 23.6 ± 1.5 kg/m2) subjects with well-controlled type 1 diabetes (duration 7.9 ± 6.9 years, A1C 7.6 ± 0.9%) with/without prandial insulin. Actrapid was infused to maintain euglycemia before meals were consumed. Subjects consumed two identical meals on separate occasions, and Rameal was measured using a dual isotope method. [6,6-2H2]glucose was incorporated into the meal (0.081 g/kg body wt), and a primed constant/variable rate infusion of [1,2,3,4,5,6,6-2H2]glucose was administered. In the tests with prandial insulin, an additional bolus dose of Actrapid was given 20 min before the meal at 0.1 units/kg body wt.
RESULTS—Insulin concentration with prandial insulin was significantly higher than during basal insulin studies (119 ± 16 vs. 66 ± 15 pmol/l, P = 0.03 by paired t test). Despite differences in insulin concentration, there were no differences in total glucose appearance (3,398 ± 197 vs. 3,307 ± 343 μmol/kg) or time taken for 25% (33.1 ± 3.3 vs. 31.7 ± 3.5 min), 50% (54.6 ± 3.5 vs. 54.1 ± 4.7 min), and 75% (82.9 ± 7.1 vs. 82.8 ± 5.8 min) of total glucose appearance. The fraction of the glucose dose appearing in the circulation was the same for basal (73 ± 8%) and prandial (75 ± 4%) study days.
CONCLUSIONS—These results suggest that meal glucose appearance is independent of prandial insulin concentration in people with type 1 diabetes.
Footnotes
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Published ahead of print at http://care.diabetesjournals.org on 23 July 2008.
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See accompanying editorial, p. 2230.
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- Accepted July 16, 2008.
- Received April 11, 2008.
- DIABETES CARE
