Relationship between oral glucose tolerance and insulin sensitivity in healthy man and type 1 diabetic patients

1986 ◽  
Vol 112 (3) ◽  
pp. 355-360 ◽  
Author(s):  
Hannele Yki-Järvinen ◽  
Eero Helve ◽  
Veikko A. Koivisto
Keyword(s):  
Insulin Sensitivity ◽  
Glucose Metabolism ◽  
Glucose Tolerance ◽  
Normal Subjects ◽  
Oral Glucose ◽  
Diabetic Patients ◽  
Oral Glucose Tolerance ◽  
Healthy Man ◽  
Type 1 Diabetic Patients

Abstract. The relationship between insulin sensitivity and oral glucose tolerance was studied in 8 conventionally treated type 1 diabetic patients (age 34 ± 4 years, relative body weight (RBW) 113 ± 5%) and in 11 healthy subjects (age 35 ± 3 years, RBW 114 ± 2%). In each subject and patient, oral glucose tolerance (75 g glucose) and in vivo sensitivity to insulin (euglycaemic clamp technique, 1 mU/kg/min insulin infusion) were measured. The response to oral glucose in the diabetic patients was measured during maintenance of similar peripheral plasma free insulin levels as in the normal subjects during the oral glucose tolerance test (OGTT). During the OGTT, the post-glucose plasma glucose values in the diabetic patients were markedly higher (P < 0.001) than in the normal subjects. During the clamp study, the rate of glucose metabolism in the diabetic patients (4.53 ± 0.58 mg/kg/min) was 37% lower than in the normal subjects (7.19 ± 0.67 mg/kg/min, P < 0.02). The area under the glucose curve was inversely related to the rate of glucose metabolism in both the diabetic (r = −0.72, P < 0.02) and the normal (r = −0.69, P < 0.02) subjects. The slope of the curve was substantially steeper in the diabetic than the control subjects. Thus, peripheral insulin sensitivity contributes to oral glucose tolerance both in healthy man, and even to a greater extent, in type 1 diabetic patients.

Glucose Tolerance in Depression

1968 ◽  
Vol 114 (510) ◽  
pp. 627-630 ◽  
Author(s):  
Brenda Herzberg ◽  
Alec Coppen ◽  
Vincent Marks
Keyword(s):  
Glucose Tolerance ◽  
Severe Depression ◽  
Normal Subjects ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Diabetic Patients ◽  
Extensive Literature ◽  
Oral Glucose Tolerance ◽  
Intravenous Glucose ◽  
Glucose Tolerance Tests

There have been many reports which suggest that there may be abnormal glucose metabolism in severe depression. Glycosuria was first reported nearly 60 years ago (Allers, 1914). In 1919, using an oral glucose tolerance test, Kooy observed decreased tolerance in a heterogeneous group of mentally ill patients which included melancholics. Since then many investigators have reported decreased glucose tolerance in depressive illness, and the extensive literature is reviewed by McFarland and Goldstein (1939) and Altschule (1953). Oral glucose tolerance tests have usually shown high or delayed peaks and a slow return to fasting levels, although the latter are usually reported normal. Intravenous glucose tolerance tests have also shown results nearer those obtained in diabetic patients than in normal subjects. Pryce (1958) reported decreased glucose tolerance with intravenous tests in a sample of 20 depressed patients, and he also found that glucose tolerance did not alter significantly after clinical recovery. Glucose supplements were added to the diet of six patients prior to testing, but he concluded that these supplements did not appear to alter glucose tolerance.

Intestinal transit of a glucose bolus and incretin kinetics: a mathematical model with application to the oral glucose tolerance test

2011 ◽  
Vol 300 (6) ◽  
pp. E955-E965 ◽  
Author(s):  
Serenella Salinari ◽  
Alessandro Bertuzzi ◽  
Geltrude Mingrone
Keyword(s):  
Mathematical Model ◽  
Gastric Emptying ◽  
Insulin Sensitivity ◽  
Glucose Tolerance ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Glucose Absorption ◽  
Oral Glucose ◽  
Diabetic Patients ◽  
Oral Glucose Tolerance

The rate of appearance (Ra) of exogenous glucose in plasma after glucose ingestion is presently measured by tracer techniques that cannot be used in standard clinical testing such as the oral glucose tolerance test (OGTT). We propose a mathematical model that represents in a simple way the gastric emptying, the transport of glucose along the intestinal tract, and its absorption from gut lumen into portal blood. The model gives the Ratime course in terms of parameters with a physiological counterpart and provides an expression for the release of incretin hormones as related to glucose transit into gut lumen. Glucose absorption was represented by assuming two components related to a proximal and a distal transporter. Model performance was evaluated by numerical simulations. The model was then validated by fitting OGTT glucose and GLP-1 data in healthy controls and type 2 diabetic patients, and useful information was obtained for the rate of gastric emptying, the rate of glucose absorption, the Raprofile, the insulin sensitivity, and the glucose effectiveness. Model-derived estimates of insulin sensitivity were well correlated ( r = 0.929 in controls and 0.886 in diabetic patients) to data obtained from the euglycemic hyperinsulinemic clamp. Although the proposed OGTT analysis requires the measurement of an additional hormone concentration (GLP-1), it appears to be a reasonable choice since it avoids complex and expensive techniques, such as isotopes for glucose Rameasurement and direct assessment of gastric emptying and intestinal transit, and gives additional correlated information, thus largely compensating for the extra expense.

RETINAL STUDIES IN PATIENTS WITH HYPERGLYCAEMIA, HYPOINSULINAEMIA AND HYPERLIPIDAEMIA ASSOCIATED WITH HYPOPITUITARISM

1974 ◽  
Vol 75 (3) ◽  
pp. 503-513
Author(s):  
N. A. Samaan ◽  
S. G. Ouais
Keyword(s):  
Growth Hormone ◽  
Glucose Tolerance ◽  
Normal Subjects ◽  
Oral Glucose ◽  
Diabetic Patients ◽  
Insulinogenic Index ◽  
Oral Glucose Tolerance ◽  
Arginine Infusion ◽  
Family History Of Diabetes ◽  
History Of

ABSTRACT Twenty-four patients who had a 10-year history of hypopituitarism resulting from treated chromophobe adenoma, without known family history of diabetes, were studied during oral glucose tolerance (GTT), arginine infusion, and insulin tolerance (ITT) tests. All patients were receiving thyroid and cortisone replacement. Serum immunoreactive growth hormone (HGH) was subnormal in all patients compared with normal subjects during both arginine infusion and ITT tests (P < 0.001). Although 9 of this hypopituitary group were diabetic, all patients showed a subnormal peak immunoreactive insulin rise during an arginine infusion test and subnormal insulinogenic index during an oral glucose tolerance test, when compared with normal subjects in the same age range. Fasting plasma triglycerides were elevated in the majority of patients, serum cholesterol in 8 while free fatty acids were high in all patients. Hyperglycaemia, hypoinsulinaemia, hyperlipidaemia and low growth hormone levels were not associated with any of the clinical signs of vascular disease frequently seen in diabetic patients.

Minimal and Maximal Models to Quantitate Glucose Metabolism: Tools to Measure, to Simulate and to Run in Silico Clinical Trials

2021 ◽  
pp. 193229682110152
Author(s):  
Claudio Cobelli ◽  
Chiara Dalla Man
Keyword(s):  
Clinical Trials ◽  
Insulin Sensitivity ◽  
Glucose Metabolism ◽  
Glucose Tolerance ◽  
In Silico ◽  
Oral Glucose ◽  
Minimal Models ◽  
Glucose System ◽  
Maximal Models

Several models have been proposed to describe the glucose system at whole-body, organ/tissue and cellular level, designed to measure non-accessible parameters (minimal models), to simulate system behavior and run in silico clinical trials (maximal models). Here, we will review the authors’ work, by putting it into a concise historical background. We will discuss first the parametric portrait provided by the oral minimal models—building on the classical intravenous glucose tolerance test minimal models—to measure otherwise non-accessible key parameters like insulin sensitivity and beta-cell responsivity from a physiological oral test, the mixed meal or the oral glucose tolerance tests, and what can be gained by adding a tracer to the oral glucose dose. These models were used in various pathophysiological studies, which we will briefly review. A deeper understanding of insulin sensitivity can be gained by measuring insulin action in the skeletal muscle. This requires the use of isotopic tracers: both the classical multiple-tracer dilution and the positron emission tomography techniques are discussed, which quantitate the effect of insulin on the individual steps of glucose metabolism, that is, bidirectional transport plasma-interstitium, and phosphorylation. Finally, we will present a cellular model of insulin secretion that, using a multiscale modeling approach, highlights the relations between minimal model indices and subcellular secretory events. In terms of maximal models, we will move from a parametric to a flux portrait of the system by discussing the triple tracer meal protocol implemented with the tracer-to-tracee clamp technique. This allows to arrive at quasi-model independent measurement of glucose rate of appearance (Ra), endogenous glucose production (EGP), and glucose rate of disappearance (Rd). Both the fast absorbing simple carbs and the slow absorbing complex carbs are discussed. This rich data base has allowed us to build the UVA/Padova Type 1 diabetes and the Padova Type 2 diabetes large scale simulators. In particular, the UVA/Padova Type 1 simulator proved to be a very useful tool to safely and effectively test in silico closed-loop control algorithms for an artificial pancreas (AP). This was the first and unique simulator of the glucose system accepted by the U.S. Food and Drug Administration as a substitute to animal trials for in silico testing AP algorithms. Recent uses of the simulator have looked at glucose sensors for non-adjunctive use and new insulin molecules.

Insulin resistance is localized to skeletal but not heart muscle in type 1 diabetes

1993 ◽  
Vol 264 (5) ◽  
pp. E756-E762 ◽  
Author(s):  
P. Nuutila ◽  
J. Knuuti ◽  
U. Ruotsalainen ◽  
V. A. Koivisto ◽  
E. Eronen ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Glucose Uptake ◽  
Compartment Model ◽  
Normal Subjects ◽  
Whole Body ◽  
Diabetic Patients ◽  
Uptake Rates ◽  
Arm Muscles ◽  
Type 1 Diabetic Patients

To determine the tissue localization of insulin resistance in type 1 diabetic patients, whole body and regional glucose uptake rates were determined under euglycemic hyperinsulinemic conditions. Leg, arm, and heart glucose uptake rates were measured using positron emission tomography-derived 2-deoxy-2-[18F]-fluoro-D-glucose kinetics and the three-compartment model described by Sokoloff et al. (L. Sokoloff, M. Reivich, C. Kennedy, M.C. DesRosiers, C.S. Patlak, K.D. Pettigrew, O. Sakurada, and M. Shinohara. J. Neurochem. 28: 897–916, 1977) in eight type 1 diabetic patients and eight matched normal subjects. Whole body glucose uptake was quantitated by the euglycemic insulin clamp technique. Whole body glucose uptake was approximately 31% lower in the diabetic patients (P < 0.01) than in the normal subjects, thus confirming the presence of whole body insulin resistance. The rate of glucose uptake was approximately 45% lower in leg muscle when measured in the femoral region (55 +/- 7 vs. 102 +/- 13 mumol.kg muscle-1.min-1, diabetic patients vs. normal subjects, P < 0.05) and approximately 27% lower in the arm muscles (66 +/- 4 vs. 90 +/- 13 mumol.kg muscle-1.min-1, respectively, P < 0.05), whereas no difference was observed in heart glucose uptake [789 +/- 80 vs. 763 +/- 58 mumol.kg muscle-1.min-1 not significant (NS)]. Whole body glucose uptake correlated with glucose uptake in femoral (r = 0.93, P < 0.005) and arm muscles (r = 0.66, P < 0.05) but not with glucose uptake in the heart (r = 0.04, NS). We conclude that insulin resistance in type 1 diabetic patients is localized to skeletal muscle, whereas heart glucose uptake is unaffected.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Insulin sensitivity obtained from the oral glucose tolerance test and its relationship with birthweight

2007 ◽  
Vol 27 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Yıldız Dallar ◽  
Dilek Dilli ◽  
Ilknur Bostancı ◽  
Elmas Öğüş ◽  
Şeyda Doğankoç ◽  
...  
Keyword(s):  
Insulin Sensitivity ◽  
Glucose Tolerance ◽  
Oral Glucose Tolerance Test ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance
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