To assess the possible role of increased insulin clearance in the pathogenesis of the dawn phenomenon, we compared plasma free-insulin concentrations, free-insulin clearance rates, and plasma glucose concentrations in eight subjects with insulin-dependent diabetes mellitus (IDDM) during infusion of insulin from midnight to 0800 h (0.15 mU · kg−1 · min−1) with a Biostator and a Harvard pump. During infusion of insulin with the Biostator, plasma free insulin decreased 40% (from 14 ± 1 to 9 ± 1 μU/ml, P < .01), insulin clearance increased 54% (from 11 ± 1 to 17 ± 2 ml/min, P < .05), and plasma glucose increased from 101 ± 4 to 217 ± 27 mg/dl, P < .01. During infusion of insulin with the Harvard pump, neither plasma free insulin (14 ± vs. 13 ± 1 μU/ml) nor free-insulin clearance (12 ± 2 vs. 13 ± 2 ml/min) changed significantly, but plasma glucose increased from 100 ± 3 to 167 ± 21 mg/dl, P < .01. The increases in plasma glucose during infusion of insulin with the Biostator and the Harvard pump were not significantly different (t = 1.44, P = .19). When insulin was delivered directly into test tubes with the Biostator and the Harvard pump, insulin concentrations in the test tubes decreased 46% over 8 h (P < .05) with the Biostator, whereas no decrease was observed with the Harvard pump. We conclude that the dawn phenomenon can occur without an increase in insulin clearance and that the apparent overnight increase in insulin clearance observed in studies with the Biostator iS artifactual.
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Original Contributions|
July 01 1986
Occurrence of Dawn Phenomenon Without Change in Insulin Clearance in Patients With Insulin-Dependent Diabetes Mellitus
Peter J Campbell;
Peter J Campbell
Diabetes Research Laboratory, Endocrine Research Unit, Departments of Medicine and Physiology, Mayo Clinic and Mayo Medical School
Rochester, Minnesota 55905
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John E Gerich
John E Gerich
Diabetes Research Laboratory, Endocrine Research Unit, Departments of Medicine and Physiology, Mayo Clinic and Mayo Medical School
Rochester, Minnesota 55905
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Send reprint requests to John E. Gerich, M.D. at the above address.
Diabetes 1986;35(7):749–752
Article history
Received:
November 29 1985
Revision Received:
February 10 1986
PubMed:
3522315
Citation
Peter J Campbell, John E Gerich; Occurrence of Dawn Phenomenon Without Change in Insulin Clearance in Patients With Insulin-Dependent Diabetes Mellitus. Diabetes 1 July 1986; 35 (7): 749–752. https://doi.org/10.2337/diab.35.7.749
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