Circadian variation in glucose tolerance and associated changes in plasma insulin and somatostatin levels in normal volunteers

The day-time variations of blood sugar and associated changes in plasma insulin and somatostatin levels in response to glucose-glucagon load were investigated in eight healthy volunteers. The glucose-glucagon test was performed in the same subjects at 9.00 a.m., at 5.00 p.m. and at midnight after 10 hrs of fasting. The blood sugar values were higher in the midnight while the corresponding plasma insulin levels were significantly lower. Plasma somatostatin levels did not differ at the different times of the day. These results suggest that the circadian variations of the glucose tolerance are correlated to a simultaneous circadian rhythmicity in the insulin response in the sense of a decreased insulin release later in the day. Somatostatin does not seem involved in the circadian variation of beta cell responsiveness observed in healthy volunteers.     

Plasma free fatty acids in pregnant insulin-independent Natal Indian diabetics

A study was undertaken in Natal Indians to determine the insulin secretory response and the comparative degree of free fatty acidaemia in normal and insulin-independent diabetic pregnant women. The fasting plasma FFA and glucose levels were found to be substantially greater in the diabetic subjects. The pattern of plasma FFA and glucose response to exogenous insulin was similar in both groups. Endogenous insulin produced a similar FFA response, but a markedly obtunded blood sugar response occurred among the diabetics despite adequate plasma insulin levels. The significance of the differential effect of endogenous insulin on FFA and glucose metabolism in pregnant insulin-independent Natal Indian diabetics is discussed.     

Failure of exogenous insulin to inhibit insulin secretion in man

In order to explore whether or not the negative feedback mechanism of insulin per se on insulin secretion exists in man, changes in plasma C-peptide immunoreactivity (CPR), as an index of pancreatic B cells secretory function, were studied in 6 nonobese healthy volunteers in the presence of high circulating levels of exogenous insulin. 10% glucose was infused concurrently so as to maintain blood sugar at the basal level. The insulin-glucose infusion was maintained for 120 minutes, achieving mean plasma levels of 140-180 mu1/ml. After this period, the insulin infusion was continued at the same rate for an additional 10 minutes while the glucose was omitted. Despite the elevated level of circulating insulin, no significant change in plasma CPR concentration was observed so long as the blood sugar was maintained at the basal levels. Following cessation of the glucose infusion, the plasma CPR levels declined with a decrease in blood sugar level. Under the conditions of the present study, no inhibitory effect of exogenous insulin on the secretory function of the B cells was noticed.     

Oral Glucose Tolerance and Related Factors in a Normal Population Sample—II. Interrelationship of Glycerides,Cholesterol, and other Factors with the Glucose and Insulin Response

The data available from the previous paper have been analysed to determine the interaction between the blood sugar and plasma insulin responses to oral glucose and a number of other biological variables. The total sugar and insulin responses were derived by calculating the total area and the incremental area under the curves.The blood sugar area was significantly correlated with age in both men and women, particularly the former. A striking degree of correlation was found in men between the level of fasting glycerides and the blood sugar area. There was a significant correlation also in women, but this was entirely due to the presence of the older, postmenopausal individuals. A lower degree of correlation was found in both sexes between fasting glycerides and the insulin area.Obesity, as defined by three interrelated factors—ponderal index, triceps fat-fold thickness, and arm girth —was significantly correlated with the insulin area (the association being stronger in the men) and with the blood sugar area only in men.The fasting cholesterol level was correlated with obesity in both sexes but with the blood sugar area and the insulin area only in men.     

Oral Glucose Tolerance and Related Factors in a Normal Population Sample—I. Blood Sugar,Plasma Insulin,Glyceride, and Cholesterol Measurements and the Effects of Age and Sex

Oral glucose tolerance tests were performed on 220 people, a representative sample of the employees of a large pharmaceutical company. Blood sugar and plasma immunoreactive insulin levels were measured on each sample of venous blood obtained before and at half-hourly intervals for two hours after 50 g. of glucose by mouth; plasma cholesterol and glycerides were measured on the fasting sample only.Women had higher mean insulin levels throughout the test, though their mean blood sugar levels were higher only at 90 and 120 minutes. In both sexes there were positive correlations between age and the levels of blood sugar, plasma cholesterol, and plasma glycerides. Though the levels of glucose rose with age, those of insulin did not.     

Hormonal and Metabolic Studies in Pheochromocytoma

One patient with benign and another with malignant pheochromocytoma have been studied in an attempt to elucidate the effect of increased catecholamines on the response of blood sugar, unesterified fatty acids, insulin and growth hormone to a glucose load. The presence of increased catecholamines in both patients appeared to produce increased fasting plasma unesterified fatty acid levels, carbohydrate intolerance and an unusual plasma growth hormone response to glucose. There was no interference with the normal decrease in plasma unesterified fatty acids after glucose ingestion. The malignant tumour, but not the benign one, was associated with low plasma insulin levels.After removal of the benign tumour the fasting unesterified fatty acid levels became normal. In addition, following glucose ingestion there appeared to be a more normal plasma insulin and growth hormone response and improved glucose tolerance. After removal of the primary malignant tumour it is noteworthy that the distant metastases secreted abnormal amounts of both adrenaline and noradrenaline.     

Relation between blood pressure,weight, and plasma sugar and serum insulin levels in schoolchildren aged 9-12 years in Westland,Holland.

In 2388 schoolchildren aged 9-12 years who took part in a study of cardiovascular risk factors in Westland, Holland, plasma sugar concentrations were found to be positively correlated with systolic and diastolic blood pressure, independently of weight. Serum cholesterol levels were also related to systolic blood pressure in boys, but much less strongly than plasma sugar levels. The relation between serum insulin and blood pressure, independent of plasma sugar, was weak. The relation between plasma sugar and systolic pressure existed for both sexes and regardless of whether measurements were made in the morning or afternoon; its association with diastolic pressure was weaker, and was not so consistent over all groups. These findings suggest that the relations between risk factors for coronary heart disease that exist in adults are already evident in childhood.     

Absence of Feeding-Induced Variations in Plasma Insulin in Hypoglycaemic-Ketonaemic Cows

The effects of food intake on plasma insulin levels were studied in 38 cows with plasma sugar ranging from 41 to 86 mg/100 ml and acetoacetate (Acac) ranging from 0.2 to 18 mg/100 ml, measured before morning feeding. The animals were fed concentrates, silage and hay. Blood samples were taken immediately before feeding in the morning and at intervals of % to 1 hr. during the following 4 hrs. In animals with low blood Acac, plasma insulin concentrations began to increase as early as 1/2 hr. after the start of feeding and reached maxima after 2 hrs. Simultaneously Acac increased and sugar decreased markedly. Animals with Acac levels > 1 mg/100 ml had low pre-feeding insulin concentrations, and the level of the hormone did not increase after feeding. They did not show systematic changes in Acac. But plasma sugar tended to decrease when food was given, even in the absence of insulin increments in peripheral blood. Glucose was infused at a low rate (0.9 g/min.) for 18 hrs. into a hypoglycaemic, ketonaemic cow. As her glucose and ketone levels became normalized, she also responded to feeding with insulin increments. But throughout the experiment her plasma insulin remained considerably lower than in an identically treated control animal which had low Acac levels before the infusion. It appears that the endocrine adjustments during ketonaemia in cows include, beside low basal (pre-feeding) insulin levels, an inhibition of the normally occurring elevation of plasma insulin after feeding.     

Pathophysiology of post-gastrectomy hypoglycaemia

The blood glucose and plasma insulin response to oral glucose and slow intravenous infusion of glucose was determined in seven patients who had undergone partial gastrectomy or gastroenterostomy. Similar studies were conducted in normal subjects; in these experiments oral glucose administration was replaced by infusion of glucose direct into the jejunum in order to simulate the rapid gastric emptying which occurs after gastric surgery.Peak insulin levels were much higher after oral or intrajejunal glucose, though peak blood glucose levels were higher after intravenous glucose. Despite the high insulin levels occurring with oral administration the late fall in blood glucose below fasting levels was not significantly greater after oral or intrajejunal glucose than after intravenous administration of the sugar. This does not support the concept that hyperinsulinaemia alone is responsible for reactive hypoglycaemia.     

Effect of insulin pump therapy on blood pressure and the renin-angiotensin system of diabetic rats

Insulin therapy, administered by continuous subcutaneous infusion with osmotic pumps over a 28 day period at doses of 2.5 and 5.0 units/day, resulted in a statistically significant increase in body weight of diabetic rats. The concentration of blood glucose was reduced by 68% to 109 mg/dl blood sugar by the higher dose of insulin and only partial control of diabetes was achieved by the lower dose (185 mg/dl blood sugar, -39%). Blood pressure was normalized by both doses of insulin. Elevated serum angiotensin converting enzyme activity and plasma renin activity, expressed as generated angiotensin I, were unaffected by the lower dose of insulin, but were reduced by 26% and 40%, respectively at the higher dose. These data suggest that elevated serum ACE and plasma renin activity, commonly found in the streptozotocin-diabetic rat, may not be primarily responsible for hypertension in this model.     

Effectiveness of hypoglycemic agents in guinea pigs exposed to mixed gamma-neutron radiations

The effect of 200, 1000, and 5000 rads of mixed gamma-neutron radiations on total blood reducing sugar and blood glucose levels in guinea pigs was investigated 2 and 24 hours, and 9, 22, and 60 days postirradiation. In addition, the effectiveness of insulin and tolbutamide in these animals was evaluated before and after irradiation. Glucose increased to a lesser degree and later than did the nonglucose fraction of the blood sugar. Insulin and tolbutamide were at least as effective in irradiated animals as in unirradiated ones except after 5000 rads, when tolbutamide was significantly less effective. These results suggest that: (1) insufficient insulin is released by the pancreas in response to elevated blood sugar levels following irradiation; (2) the pancreas does produce insulin at these times and is able to release it in response to tolbutamide; and (3) a decrease in insulin production occurs following supralethal doses of radiation.     

Impaired Glucose Tolerance: A Late Effect of Insulin Shock Treatment

Glucose tolerance tests were performed in a group of patients in a mental hospital who had been treated with insulin shock and in a matched control group. Five out of 31 (16%) patients in the insulin-treated group and 1 out of 22 (5%) controls had “diabetic” blood sugar curves. Median blood sugar values were significantly higher at 60 minutes and later in the insulin-treated group, as were mean blood sugar values when the “diabetic” patients were excluded. Small amounts of plasma insulin-binding antibody were found in two insulin-treated patients. In the absence of any other clear-cut explanation, it is suggested that in some patients massive doses of insulin by injection may leave diminished tissue responsiveness to insulin as a long-term after-effect.     

Enhanced endogenous insulin secretion after treatment with monocomponent insulin

Eight maturity-onset diabetic patients who had no infections, liver diseases or other endocrine diseases which might affect carbohydrate metabolism were treated with monocomponent lente insulin, which is known to have little antigenicity, until blood sugar was controlled. The diurnal values of the blood sugar (BS) and immunoreactive insulin (IRI) were obtained before treatment and on the third day after the withdrawal of insulin treatment. One patient was dropped from the study because of insulin antibody formation. The total integrated IRI area in the diurnal profile was increased from 98.9 +/- 23.7 to 186.1 +/- 37.7 muU.h/ml (p less than 0.05), while the total blood sugar area was decreased from 7,500 +/- 1,200 to 5,510 +/- 1,214 mg-h% (p less than 0.05). Oral Glucose Tolerance Test on the fourth day after the withdrawal of insulin treatment showed increased IRI response compared to pretreatment. It is concluded that endogenous insulin secretion could be increased in the diabetic patient by the metabolic control with exogenous insulin injections.     

Diurnal Variation in Response to Intravenous Glucose

Intravenous glucose tolerance tests (25 g) were performed in the morning and afternoon on 13 apparently normal persons. The individual K values (rate of decline of blood sugar) were all higher in the morning tests, and the mean values were significantly higher in the morning. Fasting blood sugar levels were slightly lower in the afternoon. There was no difference between the fasting morning and afternoon plasma insulin levels, but the levels after glucose were lower in the afternoon. Growth hormone levels were low at all times in non-apprehensive subjects and unaffected by glucose. The results suggest that the impaired afternoon intravenous glucose tolerance, like oral glucose tolerance, is associated with impaired insulin release and insulin resistance.     

Impairment of cell-mediated immunity in mutation diabetic mice (db/db).

Mutation diabetes in the mouse occurs in the C57BL/Ks strain. All homozygous animals (db/db) develop obesity, elevated blood sugar levels and increased or normal blood insulin concentration. The defects in cellular immunity in db/db mice and their littermate controls were examined both in vivo and in vitro. Significant suppression of delayed footpad swelling and first and second set skin allograft rejection time were observed. In addition, DNA synthesis in spleen cells after nonspecific mitogen stimulation was markedly inhibited. Diabetic animals with a mean blood sugar of 512 +/- 101 mg/100 ml did not respond to exogenous insulin therapy by lowering their blood sugar levels or reversing the defect in DNA synthesis. Adding insulin to spleen cell culture in vitro had no demonstrable effect on their response to mitogens. Thus, mutation diabetic mice with their known defect in the peripheral utilization of insulin have markedly suppressed cell-mediated immune mechanisms.     

Possibility of long-lasting amplification of insulin receptors by a single treatment at newborn age.

Administration of insulin to newborn rats was shown to amplify the hormone receptors. Blood sugar values in animals thus treated were lower in the adult age, which could be explained by increased sensitivity to endogenous insulin; the decrease of blood sugar in response to exogenous insulin was similar in magnitude, however, it occurred at a lower level compared to the controls. These changes were more marked in female than in male rats.     

Mechanisms of central regulation of blood sugar content]

Acute experiments were conducted on adult cats. Injection of insulin microdose (0.025 U/kg with 0.025 ml of saline) into the posterior hypothalamic nucleus caused an increase in the blood sugar level 10 and 70 min after the injection. Changes of the blood sugar level correlated with the EEG activation of the posterior hypothalamic nucleus in response to the insulin injection, spreading to the lateral hypothalamus. However, hormonal stimulation of the posterior hypothalamic nucleus against the background of bilateral coagulation of the lateral hypothalamus produced no increase in the blood sugar level in 10 min. This is indicative of the participation of the lateral hypothalamus in the realization of hyperglycemic reactions in response to the insulin injection into the posterior hypothalamic nucleus.     

Pancreatic hormonal and metabolic responses in overfed ducks.

When overfed at their maximum (intensive overfeeding) or at only 80% (moderate overfeeding) of food intake capacity, Mule ducks developed strong liver steatosis, whereas Pekin ducks showed very marked extrahepatic fattening. During overfeeding, evolution of plasma glucose and triacylglycerol concentrations suggested a very strong increase in the hepatic lipogenesis as well as genotype- and diet-independent lipoprotein secretion. In contrast, lipoprotein-lipase activity was dependent on alimentary status (the intensive overfeeding induces the highest activities), and Pekin ducks showed higher lipoprotein-lipase activity than Mule ducks, which could favor extrahepatic fattening to the detriment of hepatic steatosis. In Pekin ducks, plasma pancreatic hormone concentrations are related to diet levels and blood sugar. With similar food intake, Mule ducks (moderately overfed) showed global blood insulin lower than that of Pekin ducks (intensively overfed) despite similar blood sugar levels, suggesting a trend towards reduced pancreas response to glucose in Mule ducks. This may result from their lower lipoprotein-lipase activity as previously shown in these two ducks overfed at only 60% of their maximal food intake capacity (unpublished results). These results suggest that high plasma insulin concentrations may be necessary to induce an optimum lipoprotein-lipase activity in overfed ducks.     

Repeated blood glucose and plasma insulin levels in normal volunteer subjects receiving isocaloric meals, before and after chlorpropamide and glibenclamide.

The blood glucose and plasma insulin response to the two hypoglycaemic agents, chlorpropamide (Diabenese) and glibenclamide (Daonil) was determined in normal subjects under strict metabolic control in a double blind study. The subjects were admitted to hospital for the period of the study, during which time they received four isocaloric meals per day and their physical exercise was standardised. Chlorpropamide had a prolonged hypoglycaemic effect compared with the short lived response after glibenclamide. Thy hypoglycaemic characteristics of the two preparations could not be explained simply on the insulin responses. Chlorpropamide was capable of lowering blood glucose without raising plasma insulin levels, whereas glibenclamide produced a prolonged and marked increase in plasma insulin levels only to be associated with a short-lived hypoglycaemic response. The latter suggested that a degree of insulin resistance had been produced secondary to the early profound lowering of the blood glucose following glibenclamide. The data indicate therefore the need for caution in extrapolating to diabetic subjects the hypoglycaemic characteristics of an agent such as glibenclamide derived from studies in normal subjects.     

Hypoglycemic activity of Swertia chirayita (Roxb ex Flem) Karst

Hexane fraction of S. chirayita (250 mg/kg body wt.) induced significant fall in blood sugar and significant increase in plasma IRI simultaneously after single oral administration without influencing liver glycogen concentration in albino rats. On the other hand, daily administration for 28 days resulted in significant lowering of blood sugar and increase in plasma IRI along with a significant rise in liver glycogen. Intestinal absorption of glucose was not inhibited by hexane fraction. It is suggested that hexane fraction of S. chirayita possibly acts through its insulin releasing effect.