Diabetes, Vol 38, Issue 5 580-588, Copyright © 1989 by American Diabetes Association

ARTICLES

Bedtime insulin for suppression of overnight free-fatty acid, blood glucose, and glucose production in NIDDM

MR Taskinen, T Sane, E Helve, SL Karonen, EA Nikkila and H Yki-Jarvinen
Second Department of Medicine, University of Helsinki, Finland.

We studied the clinical effectiveness and mechanism underlying the glucose-lowering effect of evening insulin therapy. Nocturnal profiles of blood glucose, plasma free fatty acid (FFA), glycerol, and lactate and overnight glucose kinetics [( 3-3H] glucose infusion) were measured in 15 non-insulin-dependent diabetic (NIDDM) patients with a relative body weight of 128 +/-4% who were poorly controlled with oral therapy alone. The patients were studied before and 2 wk and 3 mo after bedtime insulin (23 +/- 3 IU) was given in addition to oral therapy. An early-morning rise in blood glucose (greater than 31 mg/dl = 1.5 mM) was present in two-thirds of the patients and was associated with an overnight rise in plasma FFA and an increase in glucose production (Ra) during the early-morning hours (change 0.42 +/- 0.10 mg.kg-1.min-1, P less than .05, between 0300 and 0800). The overnight mean levels of blood glucose, plasma FFA, and serum insulin averaged 212 +/- 9 vs. 137 +/- 11 vs. 133 +/- 11 mg/dl (P less than .001), 674 +/- 61 vs. 491 +/- 57 vs. 484 +/- 36 microM (P less than 0.01) and 12.7 +/- 1.6 vs. 18.1 +/- 2.2 vs. 20.7 +/- 2.4 microU/L (P less than .01) before and 2 wk and 3 mo after the combination therapy. The decrements in overnight glucose and FFA levels after 2 wk of bedtime insulin therapy were closely correlated (r = .86, (P less than .001). The nocturnal profile of plasma lactate was similar before and during bedtime insulin therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				S. P. Kim, K. J. Catalano, I. R. Hsu, J. D. Chiu, J. M. Richey, and R. N. Bergman Nocturnal free fatty acids are uniquely elevated in the longitudinal development of diet-induced insulin resistance and hyperinsulinemia Am J Physiol Endocrinol Metab, June 1, 2007; 292(6): E1590 - E1598. [Abstract] [Full Text] [PDF]

				S. Vehkavaara and H. Yki-Jarvinen 3.5 Years of Insulin Therapy With Insulin Glargine Improves In Vivo Endothelial Function in Type 2 Diabetes Arterioscler. Thromb. Vasc. Biol., February 1, 2004; 24(2): 325 - 330. [Abstract] [Full Text]

				M. C. Riddle, J. Rosenstock, and J. Gerich The Treat-to-Target Trial: Randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients Diabetes Care, November 1, 2003; 26(11): 3080 - 3086. [Abstract] [Full Text] [PDF]

				J. M. Miles, D. Wooldridge, W. J. Grellner, S. Windsor, W. L. Isley, S. Klein, and W. S. Harris Nocturnal and Postprandial Free Fatty Acid Kinetics in Normal and Type 2 Diabetic Subjects: Effects of Insulin Sensitization Therapy Diabetes, March 1, 2003; 52(3): 675 - 681. [Abstract] [Full Text] [PDF]

				M D. Robertson, R A. Henderson, G. E Vist, and R D. E Rumsey Extended effects of evening meal carbohydrate-to-fat ratio on fasting and postprandial substrate metabolism Am. J. Clinical Nutrition, March 1, 2002; 75(3): 505 - 510. [Abstract] [Full Text] [PDF]

				S. Vehkavaara, S. Makimattila, A. Schlenzka, J. Vakkilainen, J. Westerbacka, and H. Yki-Jarvinen Insulin Therapy Improves Endothelial Function in Type 2 Diabetes Arterioscler. Thromb. Vasc. Biol., February 1, 2000; 20(2): 545 - 550. [Abstract] [Full Text] [PDF]

				R. Basu, A. Basu, M. Nielsen, P. Shah, and R. A. Rizza Effect of Overnight Restoration of Euglycemia on Glucose Effectiveness in Type 2 Diabetes Mellitus J. Clin. Endocrinol. Metab., July 1, 1999; 84(7): 2314 - 2319. [Abstract] [Full Text]

				J. A. Colwell The Feasibility of Intensive Insulin Management in Non-Insulin-dependent Diabetes Mellitus: Implications of the Veterans Affairs Cooperative Study on Glycemic Control and Complications in NIDDM Ann Intern Med, January 1, 1996; 124(1_Part_2): 131 - 135. [Abstract] [Full Text]