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Insulin sensitivity in the initial phase of type 1 diabetes mellitus
Insights
In early Type 1 diabetes, insulin sensitivity varies with disease severity. Mild cases show normal or high insulin sensitivity, while severe cases exhibit significant insulin resistance.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
Background:
- Type 1 diabetes is an autoimmune disease characterized by insulin deficiency.
- Understanding insulin sensitivity is crucial for managing diabetes, especially in children.
- Early-phase Type 1 diabetes presents unique challenges in metabolic regulation.
Purpose of the Study:
- To investigate the blood glucose response to insulin in children with early-stage Type 1 diabetes.
- To assess the relationship between insulin sensitivity and the severity of diabetic metabolic derangement.
- To compare insulin sensitivity in diabetic children with that of healthy controls.
Main Methods:
- A brief insulin infusion (0.012 U/kg body weight) was administered to 21 children with Type 1 diabetes and 20 healthy controls.
- Blood glucose levels were monitored to determine the glucose decrement percentage.
- Diabetic children were subgrouped based on metabolic derangement severity.
Main Results:
- Insulin effect was impaired in most diabetic children compared to controls (14.3% vs. 20.9% glucose decrement).
- Children with mild metabolic derangement showed normal or supranormal insulin sensitivity (36.2% decrement).
- Children with severe metabolic derangement displayed marked insulin resistance (5.6% decrement).
- Significant correlations were found between glucose decrement and fasting blood glucose, glucose assimilation rate, and oral glucose tolerance test (OGTT) results.
- Four insulin-resistant patients showed normal insulin sensitivity during remission.
Conclusions:
- Insulin sensitivity in early Type 1 diabetes is inversely related to the severity of metabolic derangement.
- Children with more severe diabetes exhibit significant insulin resistance.
- Remission of diabetes can restore normal insulin sensitivity.
Abstract:
The blood glucose response to a brief infusion of insulin (0.012 U/kg body wt) was studied in the initial phase of Type 1 diabetes in 21 children and in 20 healthy controls. The insulin effect was impaired in most of the diabetics and the mean blood glucose decrement was 14.3 +/- 3.5% (SEM) as compared with 20.9 +/- 2.1% in the normals. Subgrouping the diabetics according to the severity of the diabetic condition revealed normal (or even supranormal) sensitivity in the diabetics with mild metabolic derangement (mean blood glucose decrement 36.2 +/- 6.0%). In children with more disturbed metabolism mean blood glucose decrement was only 5.6 +/- 0.8% indicating a marked insulin resistance. Further evidence for a relationship between the insulin sensitivity and the severity of the diabetic state was found in the correlation between the percentual blood glucose decrement and the fasting blood glucose (r = -0.79, p less than 0.01), the glucose assimilation rate (r = 0.71, p less than 0.01), as well as the blood glucose level at 120 min during the OGTT (r = -0.76, p less than 0.01). Four of the insulin-resistant patients were re-tested during remission and exhibited then normal insulin sensitivity.