Increased responsiveness to exogenous insulin administration in the hyperglycemic obese person with type II diabetes

This study was undertaken to investigate whether obese persons with type II diabetes mellitus showed less of a response to the hypoglycemic effect of insulin treatment than did lean type II diabetic patients. Forty-three patients (lean, n = 17; obese, n = 22; obese on hypercaloric diets, n = 4) were treated with insulin and placed on a diet calculated to maintain ideal body weight. A rapid decrease in the mean serum glucose concentration was seen in both the lean and obese groups following the initiation of insulin therapy. The glucose concentration of the lean patients plateaued after the second day of insulin treatment, whereas the obese patients' levels continued to fall after the third and fourth days. A difference was noted in the caloric intake of the two groups. Lean patients ingested 28 kCal/kg/day; obese patients ingested 17 kCal/kg/day. An additional group of four obese diabetic patients who ingested 28 kCal/kg/day was studied to determine if the hypocaloric intake of the first group of obese patients had altered their responsiveness to insulin. Despite the higher caloric intake, the mean serum glucose concentration of this group of patients fell more rapidly than did that of the lean patients. Caloric intake during the initiation of insulin therapy does not seem to influence the increase in insulin responsiveness of obese insulin-requiring type II diabetic patients.