| Nonlinear metabolic effect of insulin across the blood glucose range in patients with type 1 diabetes mellitus. | |
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MedLine Citation:
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PMID: 20663451 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: For insulin therapy to successfully maintain blood glucose (BG) levels of patients with type 1 diabetes mellitus (T1DM) in normoglycemia, it is necessary to understand if the metabolic effect of insulin across the BG range is linear or not. METHODS: We assess the ability of insulin to lower BG in patients with T1DM in hypoglycemia and hyperglycemia. The net metabolic effect of insulin, defined as the total effect resulting from both reduced endogenous glucose production and increased glucose uptake, was used to define the insulin effectiveness (IE), a measure that indicates the amplitude of glucose lowering that a unit of active insulin can achieve at a given BG level. The IE was assessed in hypoglycemia and hyperglycemia through two separate studies. In the first study, patients were subjected to a hyperinsulinemic euglycemic and hypoglycemic glucose clamp. In the second study, another group of patients were clamped at a hyperglycemic level. RESULTS: The IE increased by 75% when BG dropped from 90 to 50 mg/dl at a steady rate of 1 mg/dl/min and decreased by 10% when BG was increased from 100 to 200 mg/dl. CONCLUSIONS: The net metabolic effect of insulin is nonlinear across the BG range and is amplified in hypoglycemia and dampened in hyperglycemia. Most importantly, the BG lowering per unit of insulin is accelerated when falling into hypoglycemia. The understanding of the accelerated risk for hypoglycemia with falling glucose levels will help the design of more robust hypoglycemia prevention and detection systems. |
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Authors:
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Alice Chan; Lutz Heinemann; Stacey M Anderson; Marc D Breton; Boris P Kovatchev |
Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2010-07-01 |
Journal Detail:
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Title: Journal of diabetes science and technology Volume: 4 ISSN: 1932-2968 ISO Abbreviation: J Diabetes Sci Technol Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-07-28 Completed Date: 2010-11-04 Revised Date: 2011-08-01 |
Medline Journal Info:
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Nlm Unique ID: 101306166 Medline TA: J Diabetes Sci Technol Country: United States |
Other Details:
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Languages: eng Pagination: 873-81 Citation Subset: IM |
Copyright Information:
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2010 Diabetes Technology Society. |
Affiliation:
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Diabetes Technology Center, University of Virginia Health System, Charlottesville, Virginia 22908-4888, USA. alicechan@virginia.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Algorithms Blood Glucose / analysis, metabolism* Diabetes Mellitus, Type 1 / blood* Female Glucose / metabolism Glucose Clamp Technique Humans Hypoglycemia / drug therapy Hypoglycemic Agents / blood, therapeutic use* Insulin / blood, therapeutic use* Male Middle Aged Nonlinear Dynamics Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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R01 DK085623-02/DK/NIDDK NIH HHS; R01 DK085623-03/DK/NIDDK NIH HHS; R01DK 51562/DK/NIDDK NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Blood Glucose; 0/Hypoglycemic Agents; 11061-68-0/Insulin; 50-99-7/Glucose |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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