The aim of this study was to investigate the role of plasma glucagon levels on the blood glucose response to intravenous insulin administered continuously or in a pulsatile manner. Six type I diabetic patients proven to have no residual insulin secretion were investigated. Endogenous glucagon secretion was inhibited by a continuous intravenous infusion of somatostatin (100 μg/h) and replaced by exogenous infusions of the hormone at three different rates (7.5, 4.5, and 2.5 μg/h), resulting in three different plasma glucagon steady-state levels (i.e., ≃200, ≃130, and ≃75 pg/ml, respectively). Each subject, in random order and on different days, was infused intravenously with regular human insulin either continuously (0.17 mU · kg−1 · min−1) or with the same amount of insulin infused in a pulsatile manner (0.85 mU · kg−1 · min−1 during 2 min followed by 8 min during which no insulin was infused). At plasma glucagon levels ≃200 pg/ml, blood glucose rose from ∼10 to ∼13 mM without any difference between the two modalities of insulin infusion. For plasma glucagon levels ≃130 pg/ml, plasma glucose remained steady throughout the experiments, but during the last 40 min, plasma glucose levels were significantly lower when insulin was administered intermittently. This greater blood glucose-lowering effect of pulsatile insulin occurred earlier and was more pronounced for plasma glucagon levels averaging 75 pg/ml. We conclude that the greater hypoglycemic effect of insulin administered intravenously in a pulsatile manner in type I diabetics critically depends on plasma glucagon circulating levels.
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May 01 1987
Greater Efficacy of Pulsatile Insulin in Type I Diabetics Critically Depends on Plasma Glucagon Levels
Giuseppe Paolisso;
Giuseppe Paolisso
Istituto di Clinica Medica II, Facoltà di Medicina, Università degli Studi di Napoli
Naples, Italy
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Saverio Sgambato;
Saverio Sgambato
Istituto di Clinica Medica II, Facoltà di Medicina, Università degli Studi di Napoli
Naples, Italy
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Nicola Passariello;
Nicola Passariello
Istituto di Clinica Medica II, Facoltà di Medicina, Università degli Studi di Napoli
Naples, Italy
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André Scheen;
André Scheen
Division of Diabetes, Institute of Medicine, University of Liège
Liège, Belgium
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Felice D'Onofrio;
Felice D'Onofrio
Istituto di Clinica Medica II, Facoltà di Medicina, Università degli Studi di Napoli
Naples, Italy
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Pierre J Lefébvre
Pierre J Lefébvre
Division of Diabetes, Institute of Medicine, University of Liège
Liège, Belgium
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Address correspondence and reprint requests to Prof, P, J, Lefèbvre, Institut de Médecine, Hôpital de Bavière, Blv. de la Constitution, 66, B-4020 Liège, Belgium.
Diabetes 1987;36(5):566–570
Article history
Received:
July 16 1986
Revision Received:
October 02 1986
Accepted:
October 02 1986
PubMed:
2883055
Citation
Giuseppe Paolisso, Saverio Sgambato, Nicola Passariello, André Scheen, Felice D'Onofrio, Pierre J Lefébvre; Greater Efficacy of Pulsatile Insulin in Type I Diabetics Critically Depends on Plasma Glucagon Levels. Diabetes 1 May 1987; 36 (5): 566–570. https://doi.org/10.2337/diab.36.5.566
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