Diurnal Variation of Oral Glucose Tolerance: a Possible Pointer to the Evolution of Diabetes Mellitus

Possible diurnal variation in the blood sugar response to oral glucose was studied by comparing, in the same individuals, the results of oral glucose tolerance tests performed in the morning and the afternoon. In a group of normal individuals the blood sugar levels were significantly higher in the afternoon. In hyperglycaemic individuals the diurnal variation decreased as the blood sugar levels reached during the morning test increased, so that in a group of grossly hyperglycaemic men the mean morning and afternoon tests were almost identical. The causes of this diurnal variation are not known.     

Diurnal Variation in Glucose Tolerance: Associated Changes in Plasma Insulin,Growth Hormone,and Non-esterified

Oral glucose tolerance tests were performed in the morning and afternoon of separate days on 31 people derived from a normal population sample. Blood sugar levels were higher in the afternoon test from and including 60 minutes after the glucose load. The degree of diurnal variation was similar in men and women, but greater in the older half of the group. It was negatively correlated with the degree of obesity. The plasma insulin response was less at the 30 minute time point in the afternoon, but significantly exceeded the morning values at 120 and 150 minutes after the glucose load. Growth hormone levels were similar in morning and afternoon tests. Fasting non-esterified fatty acid levels were significantly higher before the afternoon test.The relatively impaired glucose tolerance in the afternoon is associated with a delayed insulin response to the glucose load. This seems unlikely to be the sole explanation, however, and increased non-esterified fatty acid metabolism with a consequent decrease in glucose disposal may also contribute.     

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.     

Diurnal Variation in Oral Glucose Tolerance: Blood Sugar and Plasma Insulin Levels Morning,Afternoon, and Evening

Twenty-four subjects received three oral glucose tolerance tests, in the morning, afternoon, and evening of separate days. The mean blood sugar levels in the afternoon and evening tests were similar, and they were both significantly higher than those in the morning test. Plasma immunoreactive insulin levels, however, were highest in the morning test. The pattern of insulin levels during the afternoon and evening tests resembled that described as typical of maturity-onset diabetes.     

食蟹猴血液学及血清生化指标日间节律性变化

目的研究食蟹猴血液学及血清生化指标日间节律性变化,为正确全面评估血液学及血清生化测定结果提供一定的实验事实依据。方法在9：30（am）～10：30（am）、12：30（pm）～13：30（pm）、15：30（pm）～16：30（pm）及19：30（pm）～20：30（pm）4个时间段对12只食蟹猴（雌雄各半）采血。采用全自动血细胞分析仪及血液生化分析仪分别测定血液学及血清生化指标。利用高效液相色谱（HPLC）方法分析血浆中皮质醇含量。结果雌雄食蟹猴下午白细胞数（WBC）及尿素氮（BUN）显著升高;雌性食蟹猴下午血红蛋白（HGB）及血细胞压积（HCT）显著降低,天门冬氨酸氨基转换酶（AST）及丙氨酸氨基转换酶（ALT）活性显著升高;雄性食蟹猴下午血糖（GLU）及血浆皮质醇显著降低。结论雌雄食蟹猴血液学及血清生化部分指标存在明显的日间节律性。     

Carbohydrate metabolism in pregnancy. Part I. Diurnal plasma glucose profile in normal and diabetic women.

Diurnal plasma glucose profiles and oral glucose tolerance during pregnancy were studied in normal women, chemical diabetics, and insulin-requiring diabetics. In normal women the mean diurnal plasma glucose rose by only 0.22 mmol/1 (4 mg/100 m1) during pregnancy. Mild chemical diabetes resulted in an increase in both the mean diurnal glucose concentration and the fluctuation of plasma glucose levels during the day. Fluctuation in glucose concentration in insulin-dependent diabetics was about three times that found in non-diabetic women of similar gestation, with relative hyperglycaemia during the day and hypoglycaemia at night. In non-diabetic women and those with chemical diabetes the mean dirunal glucose correlated closely with the total area under the three-hour oral glucose tolerance curve and significantly, but less closely, with the two-hour glucose tolerance test value.     

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.     

Influence of oral glucose load upon blood glucose level in relation to the time of day

Blood glucose levels were estimated at different times of day in fasted rats and after 30, 60,90 and 120 min, since oral glucose load. Circadian variations in basal glucose levels and in the levels after glucose load were observed with the highest values noted between 11 a.m. and 7 p.m., and the lowest ones about midnight. These variations were most prominent when the measurements were performed 60 min after glucose load. Circadian variation in glucose tolerance was also revealed with the best tolerance at about midnight while the worst one was noted at noon and in the afternoon.     

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.     

A Preliminary Investigation into Individual Differences in the Orcadian Variation of Meal Tolerance: Effects on Mood and Hunger

A forced desynchrony methodology was used to assess postprandial blood glucose in 9 female volunteers during a 3-h period following a mixed meal presented at four times of day (08:00, 14:00, 20:00, 02:00). The influence of time of day on the postmeal glucose responses was evaluated by calculating the area under the curve, largest increase, time taken to reach peak, and fasting level. Circadian variations in meal tolerance were found for the area under the curve and largest increase, responses were greater (indicating poorer meal tolerance) in the evening than the morning. Fasting blood glucose exhibited diurnal variation although in the opposite direction to meal tolerance; levels were higher in the morning than the evening. Time taken to reach peak levels was not modulated by circadian rhythmicity. Estimates of the timing of poorest meal tolerance and the magnitude of this intolerance were computed for each subject. Individual differences in the magnitude of meal intolerance were found to influence hunger and self-reported calmness. Subjects with good tolerance had rhythms in both calmness and hunger, which were not found in those with poor tolerance. Subjects with good tolerance also tended to rate themselves as feeling more calm. These mood and hunger effects may result from differences in insulin resistance, which is hypothesized to underlie the circadian variations in meal tolerance. (Chronobiology International, 13(6), 435-447, 1996)     

Effect of reversing dark-light cycles on normal diurnal variation and related metabolic disturbance in rats

Diurnal variation of glucose tolerance and insulin action was studied in male Sprague-Dawley rats with a normal or reversed light-dark cycle. A series of experiments conducted was at 12 AM and 12 PM in the two groups. All measurements were separated by a recovery period of at least 3 days and preceded by a 16-hour fast. Glucose tolerance and insulin action were measured by both an oral glucose tolerance test and intraperitoneal insulin tolerance test. Normal light-dark cycle rats had significantly (P < 0.05) greater insulin sensitivity at 12 PM than at 12 AM, whereas reversed light-dark cycle rats had the opposite results (P < 0.05). Rats in the normal light-dark cycle group had a significantly higher growth hormone concentration at 12 AM than at 12 PM, whereas rats in the reversed group had the opposite results. Measurement of insulin-stimulated glucose uptake of isolated adipocytes preincubated with or without 100 ng/ml growth hormone at 37 degrees C for 5 hours revealed that approximately 30% of insulin-stimulated glucose uptake was suppressed when adipocytes were treated with growth hormone. These results indicate that male rats exhibit significant diurnal variation of glucose tolerance and insulin sensitivity, and suggest that the concomitant diurnal variation of growth hormone may have a superimposed and amplifying effects on this variation.     

Heat sensitivity of photosynthetic electron transport varies during the day due to changes in sugars and osmotic potential

In water-stressed leaves, accumulation of neutral osmotica enhances the heat tolerance of photosynthetic electron transport. There are large diurnal and day-to-day changes in leaf sugar content because of variations in net photosynthetic production, respiration and retranslocation. To test the hypothesis that diurnal and day-to-day variations in leaf sugar content and osmotic potential significantly modify the responses to temperature of photosynthetic electron transport rate, we studied chlorophyll fluorescence rise temperatures (i.e. critical temperatures at break-points in fluorescence versus temperature response curves, corresponding to enhanced damage of PSII centers and detachment of pigment-binding complexes) in the dark at a background of weak far-red light (T(FR)) and under actinic light (T(L)), and responses of foliar photosynthetic electron transport rate to temperature using gas-exchange and chlorophyll fluorescence techniques in the temperate tree Populus tremula L. Sucrose and sorbitol feeding experiments demonstrated strong increases of fluorescence rise temperatures T(FR) and T(L) with decreasing leaf osmotic potential and increasing internal sugar concentration. Similar T(FR) and T(L) changes were observed in response to natural variation in leaf sugar concentration throughout the day. Increases in leaf sugar concentration led to an overall down-regulation of the rate of photosynthetic electron transport (J), but increases in the optimum temperature (Topt) of J. For the entire dataset, Topt varied from 33.8 degrees C to 43 degrees C due to natural variation in sugars and from 33.8 degrees C to 52.6 degrees C in the sugar feeding experiments, underscoring the importance of sugars in modifying the response of J to temperature. However, the correlations between the sugar concentration and fluorescence rise temperature varied between the days. This variation in fluorescence rise temperature was best explained by the average temperature of the preceding 5 or 6 days. In addition, there was a significant year-to-year variation in heat sensitivity of photosynthetic electron transport that was associated with year-to-year differences in endogenous sugar content. Our data demonstrate a diurnal variation in leaf heat tolerance due to changes in sugar concentration, but they also show that this short-term modification in heat tolerance is super-imposed by long-term changes in heat resistance driven by average temperature of preceding days.     

Pregnancy alters diurnal variation of plasma glucose concentration

Human pregnancy introduces a diurnal variation of fasting plasma glucose concentrations, with significantly lower values found after a daytime fast of eight hours compared with a night-time fast of the same duration. The diurnal variation of plasma glucose clearance, found in nonpregnant subjects, is not demonstrable during pregnancy. Insulin tolerance does not exhibit a circadian valuation but is substantially decreased during pregnancy.     

Pregnancy Alters Diurnal Variation of Plasma Glucose Concentration

Human pregnancy introduces a diurnal variation of fasting plasma glucose concentrations, with significantly lower values found after a daytime fast of eight hours compared with a night-time fast of the same duration. The diurnal variation of plasma glucose clearance, found in nonpregnant subjects, is not demonstrable during pregnancy. Insulin tolerance does not exhibit a circadian valuation but is substantially decreased during pregnancy.     

α1-Adrenoreceptor activity does not explain lower morning endothelial-dependent, flow-mediated dilation in humans

Early morning reduction in endothelium-dependent, flow-mediated dilation (FMD) may contribute to the high incidence of sudden cardiac death at this time of day. The mechanisms underpinning diurnal variation in FMD are unclear, but potentially relate to a circadian rhythm in sympathetic nerve activity. We hypothesized that blockade of α(1)-mediated sympathetic nerve activity would act to attenuate the diurnal variation in FMD. In a randomized and placebo-controlled design, we measured brachial artery FMD in 12 participants (mean age = 26 yr, SD = 3) at 0600 and 1600 after ingestion of an α(1)-blocker (prazosin, 1 mg/20 kg body mass) or placebo. Arterial diameter and shear rate were assessed using edge-detection software. Heart rate and blood pressure were also measured. Data were analyzed using linear mixed modeling. Following placebo, FMD was 8 ± 2% in the morning compared with 10 ± 3% in the afternoon (P = 0.04). Blockade with prazosin led to a slight but nonsignificant increase in morning FMD (P = 0.24) and a significant (P = 0.04) decrease in afternoon FMD, resulting in no diurnal variation (P = 0.20). Shear rate did not differ in the morning or afternoon under either condition (P > 0.23). Blood pressure was lower following prazosin compared with placebo (P < 0.02), an effect that was similar at both times of day (P > 0.34). Heart rate and norepinephrine levels were higher in the afternoon following prazosin. These data indicate that α(1)-adrenoreceptor activity does not explain lower morning endothelium-dependent FMD.     

The effect of time-of-day and sympathetic α1-blockade on orthostatic tolerance

Tolerance time to a standardized orthostatic stressor is markedly reduced in normotensive individuals in the morning. However, the physiological mechanisms that underpin this phenomenon are unknown. The purpose of this study was to examine the role of α(1)-adrenergic activity on orthostatic tolerance and associated cardiorespiratory and cerebrovascular responses, and to determine whether its endogenous modulation is important in the diurnal variation of orthostatic tolerance. In a four-trial, randomized placebo-controlled crossover experiment, 12 normotensive volunteers (aged 25 ± 1 yrs; mean ± SE) completed a 60° head-upward tilt (HUT; 15 min or until onset of presyncope) at 06:00 and 16:00 h, 90 min after the administration of either α(1)-blockade (prazosin, 1 mg/20 kg body weight) or placebo. Continuous beat-to-beat measurements of middle cerebral blood flow velocity (transcranial Doppler), blood pressure (Finometer), heart rate, stroke volume, cardiac output, and end-tidal carbon dioxide were obtained. Independent of time-of-day, α(1)-blockade markedly reduced the ability to tolerate a 15-min 60° HUT; tolerance time was 229% shorter compared with the placebo condition (p ≤ .0001). Moreover, a marked diurnal variation in orthostatic tolerance was evident following α(1)-adrenergic blockade; e.g., tolerance time in the morning (176 ± 30 s) was lower than in the afternoon (354 ± 75 s; p =?.04). These findings highlight an important role of α(1)-sympathetic vasoconstrictor activity in acutely regulating blood pressure and offsetting syncope, especially in the early morning.     

THE EFFECTS OF VARIATIONS IN THE CONCENTRATION OF OXYGEN AND OF GLUCOSE ON DARK ADAPTATION

In this study we have analyzed the effects of variations in the concentrations of oxygen and of blood sugar on light sensitivity; i.e. dark adaptation. The experiments were carried out in an air-conditioned light-proof chamber where the concentrations of oxygen could be changed by dilution with nitrogen or by inhaling oxygen from a cylinder. The blood sugar was lowered by the injection of insulin and raised by the ingestion of glucose. The dark adaptation curves were plotted from data secured with an apparatus built according to specifications outlined by Hecht and Shlaer. During each experiment, observations were first made in normal air with the subject under basal conditions followed by one, and in most instances two, periods under the desired experimental conditions involving either anoxia or hyper- or hypoglycemia or variations in both the oxygen tension and blood sugar at the same time. 1. Dark adaptation curves were plotted (threshold against time) in normal air and compared with those obtained while inhaling lowered concentrations of oxygen. A decrease in sensitivity was observed with lowered oxygen tensions. Both the rod and cone portions of the curves were influenced in a similar way. These effects were counteracted by inhaling oxygen, the final rod thresholds returning to about the level of the normal base line in air or even below it within 2 to 3 minutes. The impairment was greatest for those with a poorer tolerance for low O₂. Both the inter- and intra-individual variability in thresholds increased significantly at the highest altitude. 2. In a second series of tests control curves were obtained in normal air. Then while each subject remained dark adapted, the concentrations of oxygen were gradually decreased. The regeneration of visual purple was apparently complete during the 40 minutes of dark adaptation, yet in each case the thresholds continued to rise in direct proportion to the degree of anoxia. The inhalation of oxygen from a cylinder quickly counteracted the effects for the thresholds returned to the original control level within 2 to 3 minutes. 3. In experiments where the blood sugar was raised by the ingestion of glucose in normal air, no significant changes in the thresholds were observed except when the blood sugar was rapidly falling toward the end of the glucose tolerance tests. However, when glucose was ingested at the end of an experiment in low oxygen, while the subject remained dark adapted, the effects of the anoxia were largely counteracted within 6 to 8 minutes. 4. The influence of low blood sugar on light sensitivity was then studied by injecting insulin. The thresholds were raised as soon as the effects of the insulin produced a fall in the blood sugar. When the subjects inhaled oxygen the thresholds were lowered. Then when the oxygen was withdrawn so that the subject was breathing normal air, the thresholds rose again within 1 to 2 minutes. Finally, if the blood sugar was raised by ingesting glucose, the average threshold fell to the original control level or even below it. 5. The combined effects of low oxygen and low blood sugar on light sensitivity were studied in one subject (W. F.). These effects appeared to be greater than when a similar degree of anoxia or hypoglycemia was brought about separately. 6. In a series of experiments on ten subjects the dark adaptation curves were obtained both in the basal state and after a normal breakfast. In nine of the ten subjects, the food increased the sensitivity of the subjects to light. 7. The experiments reported above lend support to the hypothesis that both anoxia and hypoglycemia produce their effects on light sensitivity in essentially the same way; namely, by slowing the oxidative processes. Consequently the effects of anoxia may be ameliorated by giving glucose and the effects of hypoglycemia by inhaling oxygen. In our opinion, the changes may be attributed directly to the effects on the nervous tissue of the visual mechanism and the brain rather than on the photochemical processes of the retina.     

Screening tests for diabetes detection; combined with a chest x-ray survey

A program was carried out to test the value and feasibility of performing blood sugar screening tests in conjunction with a community-wide chest x-ray survey. A simple, rapid and inexpensive blood sugar screening test requiring only about two drops of blood from the finger tip was used. Among 14,681 persons who stated that they did not have diabetes, 191 or 1.3 per cent had "positive" results in screening tests. The number of persons referred to their physicians for diagnostic study because of the possibility of diabetes was reduced from 191 to 127 by means of a more specific secondary screening test. Diagnostic information with regard to 102 of the 127 persons referred to their physicians was supplied by the physicians. In 58 (0.40 per cent of the 14,681 participants) the diagnosis was diabetes-newly discovered as a result of referral by the survey.Some of the persons referred to their physicians because of suspicion of diabetes, while not then diabetic, might be considered prediabetic. The appearance of diabetes in this group during the year following the survey was therefore investigated. Glucose tolerance tests were performed for 32 of the diabetes suspects whose diagnosis immediately following the survey was either "not diabetic" or unknown. In 15 cases the glucose tolerance curves were indicative of diabetes, in seven cases questionable and in ten cases normal. The 58 persons diagnosed immediately after the survey plus the 15 found to have "diabetic" glucose tolerance curves a year later made a total of 73 newly discovered diabetics. This is a discovery rate of 0.50 per cent among the 14,681 participants in the survey. The success of this combined diabetes detection and chest x-ray survey suggests that other screening procedures should be studied to determine the desirability of adding them to similar community-wide case-finding programs.     

Effects of dietary D-psicose on diurnal variation in plasma glucose and insulin concentrations of rats

The effects of supplemental D-psicose in the diet on diurnal variation in plasma glucose and insulin concentrations were investigated in rats. Forty-eight male Wistar rats were divided into four groups. Each group except for the control group was fed a diet of 5% D-fructose, D-psicose, or psico-rare sugar (3:1 mixture of D-fructose and D-psicose) for 8 weeks. Plasma glucose levels were lower and plasma insulin levels were higher at all times of day in the psicose and psico-rare sugar groups than in the control and fructose groups. Weight gain was significantly lower in the psicose group than in the control and fructose groups. Liver glycogen content, both before and after meals was higher in the psicose group than in the control and fructose groups. These results suggest that supplemental D-psicose can lower plasma glucose levels and reduce body fat accumulation. Hence, D-psicose might be useful in preventing postprandial hyperglycemia in diabetic patients.