Gastric emptying in Type II (non-insulin-dependent) diabetes mellitus before and after therapy readjustment: no influence of actual blood glucose concentration

Abstract. The dose-response relationships between prestimulatory blood glucose concentration and the plasma C-peptide responses to stimulation with 1 mg of glucagon iv or a standard mixed meal were studied in 8 C-peptide positive patients with insulin-dependent diabetes mellitus. Hyperglycemia was maintained for 90 min before stimulation using a hyperglycemic clamp technique. Each test was performed at the steady state blood glucose levels ~5, ~12, and ~20 mmol/l. The glucose potentiation of the incremental plasma C-peptide area under the curve at the two levels of hyperglycemia in percent of the area at normoglycemia (median and range) was 343% (53-1053) (p<0.05) and 341% (267-1027) (p<0.05) after glucagon and 140% (76-227) (NS) and 251% (95-1700) (p<0.05) after the meal. The corresponding relative glucose potentiation of plasma C-peptide 6 min after stimulation with glucagon was 124% (100-427) (p<0.02) and 144% (100-209) (p<0.05). There was no significant difference in the degree of glucose potentiation at ~12 or ~20 mmol/l. Furthermore, there was no significant difference in the degree of glucose potentiation of the different estimated values of B-cell function. In conclusion, the plasma C-peptide responses to iv glucagon or to a standard test meal were markedly potentiated by acute hyperglycemia in insulin-dependent diabetes mellitus. No further potentiation was, however, obtained when the prestimulatory blood glucose concentration was raised above 12 mmol/l. These findings contrast those reported in non-insulin-dependent diabetes, where endogenous insulin secretion is potentiated further when the blood glucose concentration is raised to ~20 mmol/l.

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DEPARTMENT OF CORRECTIONS

Pediatrics in Review ◽

10.1542/pir.12.1.21 ◽

1990 ◽

Vol 12 (1) ◽

pp. 21-21

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Children And Adolescents ◽

Glucose Concentration ◽

Blood Concentration ◽

Blood Glucose Concentration ◽

Insulin Dependent Diabetes Mellitus ◽

Insulin Dependent Diabetes ◽

Dependent Diabetes Mellitus ◽

Insulin Dependent

In the article by Ginsberg-Fellner in the February 1990 issue of Pediatrics in Review, "Insulin-Dependent Diabetes Mellitus," the blood concentration at which the kidneys excrete glucose was stated incorrectly. On page 242, the 22nd line of the section on the management of children and adolescents with diabetes should indicate that this occurs only when the blood glucose concentration is greater than 180 mg/dL.

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Effect of blood glucose concentration on osmoregulation in diabetes mellitus

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1989.256.3.r597 ◽

1989 ◽

Vol 256 (3) ◽

pp. R597-R604 ◽

Cited By ~ 3

Author(s):

C. J. Thompson ◽

S. N. Davis ◽

P. H. Baylis

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Blood Glucose Concentration ◽

Insulin Dependent Diabetes Mellitus ◽

Dependent Diabetes Mellitus ◽

Plasma Sodium ◽

Vasopressin Release ◽

Plasma Vasopressin ◽

Insulin Dependent ◽

Vasopressin Secretion

Poorly controlled insulin-dependent diabetes mellitus is associated with considerable elevations of plasma vasopressin concentrations, although well-controlled diabetics have normal osmoregulated thirst and vasopressin release. We studied the effect of blood glucose concentration on osmoregulated thirst and vasopressin secretion in insulin-dependent diabetes mellitus. Blood glucose was maintained overnight, and for the duration of the study, in either the euglycemic (4-5 mmol/l) or hyperglycemic (10-12 mmol/l) range, and patients underwent infusion of hypertonic (855 mmol/l) sodium chloride solution. Plasma sodium was lower during the hyperglycemic study, but elevation in plasma sodium concentration by infusion of saline caused progressive linear increases in both thirst and plasma vasopressin concentrations in both studies. Linear regression analysis defined lowered plasma sodium thresholds for both thirst appreciation and vasopressin release during the hyperglycemic study, although the sensitivity of the osmoreceptors remained unchanged. Analysis of the data in terms of plasma osmolality, corrected for the increase in blood glucose in the hyperglycemic study, revealed no differences in the osmotic thresholds for thirst or vasopressin release; sensitivity of the osmoreceptors also remained the same. Drinking abolished thirst and lowered plasma vasopressin concentrations before major changes in plasma sodium were observed. These results show that insulin-dependent diabetic patients osmoregulate appropriately when moderately hyperglycemic but that the threshold plasma sodium for vasopressin secretion and thirst appreciation is lowered by an unknown mechanism.

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Cisapride Versus Placebo for 8 Weeks on Glycemic Control and Gastric Emptying in Insulin-Dependent Diabetes: A Double Blind Cross-Over Trial1

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem.84.7.5859 ◽

1999 ◽

Vol 84 (7) ◽

pp. 2357-2362

Author(s):

Georg Stacher ◽

Guntram Schernthaner ◽

Mario Francesconi ◽

Hans-Peter Kopp ◽

Helmar Bergmann ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Gastric Emptying ◽

Glycemic Control ◽

Autonomic Neuropathy ◽

Insulin Dependent Diabetes Mellitus ◽

Insulin Dependent Diabetes ◽

Dependent Diabetes Mellitus ◽

Double Blind ◽

Insulin Dependent

In insulin-dependent diabetes mellitus, slow gastric emptying may make absorption unpredictable and foster glycemic instability. Cisapride accelerates emptying, but controlled long term studies are scarce, and effects on glycemic control unknown. We investigated, in patients with insulin-dependent diabetes mellitus and unstable glycemia, the effects of 10 mg cisapride 4 times daily for 8 weeks vs. placebo on glycemic control and gastric emptying under random, cross-over, double blind conditions. In 14 patients with delayed and 9 with nondelayed emptying, blood glucose variability over 2 8-week treatment periods separated by a 4-week wash-out and gastric emptying of a semisolid 1168-kJ meal immediately after the treatment periods were assessed. Cisapride did not affect glycemic control [sd of within-patient mean blood glucose, 4.2 mmol/L ± 0.1 (±sem) vs. 4.0 ± 0.1 mmol/L after placebo; hemoglobin A1c, 8.3 ± 0.2% vs. 8.5 ± 0.2%]. Emptying was faster after cisapride than after placebo in 8 of 14 patients with delayed vs. 7 of 9 with nondelayed emptying (P = NS) and in 11 of 15 without vs. 4 of 8 with cardiovascular autonomic neuropathy (P = NS). Autonomic neuropathy prevailed in 7 of 14 patients with delayed and 1 of 9 with nondelayed emptying. Blood glucose immediately before and during assessment of emptying was unrelated to the emptying rate, whereas blood glucose increases over fasting levels were greater with faster emptying (P< 0.002). In conclusion, cisapride’s effects were not different from those of placebo on glycemic control and gastric emptying, it did not differently affect patients with delayed vs. nondelayed emptying, and it slightly accelerated emptying (P = NS) in patients without, but not in those with, cardiovascular autonomic neuropathy. Blood glucose levels before and during assessment of emptying did not affect emptying, but the glucose rise over fasting levels was greater with faster emptying.

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Insulin-dependent diabetes mellitus: Gastric emptying in relation to autonomic and peripheral neuropathy and blood glucose

Gastroenterology ◽

10.1016/0016-5085(95)26905-3 ◽

1995 ◽

Vol 108 (4) ◽

pp. A648

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Peripheral Neuropathy ◽

Gastric Emptying ◽

Insulin Dependent Diabetes Mellitus ◽

Insulin Dependent Diabetes ◽

Dependent Diabetes Mellitus ◽

Insulin Dependent

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ACUTE EFFECTS OF LEG EXERCISE AND INSULIN INJECTION SITES ON BLOOD GLUCOSE IN PERSONS WITH INSULIN-DEPENDENT DIABETES MELLITUS

Medicine & Science in Sports & Exercise ◽

10.1249/00005768-199505001-00460 ◽

1995 ◽

Vol 27 (Supplement) ◽

pp. S81

Author(s):

Z. Gagalis ◽

J. H. Rimmer

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Insulin Dependent Diabetes Mellitus ◽

Insulin Injection ◽

Insulin Dependent Diabetes ◽

Dependent Diabetes Mellitus ◽

Acute Effects ◽

Leg Exercise ◽

Insulin Dependent

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Oral hypoglycaemics for diabetes: when and which?

Drug and Therapeutics Bulletin ◽

10.1136/dtb.29.4.13 ◽

1991 ◽

Vol 29 (4) ◽

pp. 13-16

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Insulin Dependent Diabetes Mellitus ◽

Insulin Dependent Diabetes ◽

Dependent Diabetes Mellitus ◽

Regular Exercise ◽

Control Blood Glucose ◽

District Policy ◽

Insulin Dependent ◽

Market Leader

People with non-insulin-dependent diabetes mellitus should modify their diet, avoid obesity and take regular exercise. An oral hypoglycaemic drug may be needed if these measures fail to control blood glucose, but it is now clear that they commonly cause hypoglycaemia. More than 3 million prescriptions were issued in 1988 for the sulphonylureas (eight currently available) and the biguanide, metformin. Glibenclamide is the market leader (1.4 million prescriptions in 1988), followed by metformin (950,000), chlorpropamide (280,000), tolbutamide (260,000) and gliclazide (200,000). Instituting a district policy to restrict the choice of sulphonylureas can improve care and save money.1 No new oral hypoglycaemics have been marketed since we last reviewed them2 but their place in overall management has been clarified.

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