Fifty-eight nondiabetic subjects and fifty-nine diabetic patients were studied to determine the pattern of postprandial plasma insulin levels. In nondiabetic subjects, including both healthy and “medical” (ill) patients, plasma insulin levels after lunch were higher in obese than in nonobese subjects but did not depend upon sex or age. The maximal value occurred forty-five to sixty minutes after the beginning of the meal. When obese and nonobese subjects were analyzed separately, no significant difference in plasma insulin values was observed between nondiabetic subjects and hyperglycemic diabetic patients not receiving insulin. A delayed insulin response occurred in obese diabetics. Obese untreated patients had higher plasma insulin levels than nonobese untreated and obese treated persons. Subjects receiving long-term oral treatment and untreated, nonobese diabetics had no difference in mean plasma insulin levels. Portal vein sampling in four maturity-onset diabetic subjects revealed low and sluggish insulin secretion after food intake. Insulin-treated diabetic patients without insulin antibodies had significantly higher plasma insulin levels than nondiabetic subjects one and two hours after the beginning of the meal. Patients receiving short-acting insulin just before lunch had higher postprandial plasma insulin values and lower blood glucose levels than diabetic subjects taking long-acting or intermediate insulin.
The pattern of postprandial blood glucose levels was studied in 11Q nondiabetic subjects and 199 diabetic patients. In nondiabetic subjects, including both healthy and "medical" (ill) patients, the maximal increase of blood glucose levels (BG) was observed forty-five to sixty minutes after the beginning of the meal, and the lowest values were seen at the second hour. The increase in blood sugar did not depend upon sex or weight, but was dependent upon age. The regression line between age and the 120 minute BG level is described by the equation: second hour BG = 0.603 X years + 89.4.Diabetic patients not treated with insulin had higher BG levels than nondiabetic individuals. There was no significant difference between untreated diabetics and those receiving sulfonylurea, biguanide or biguanide plus sulfonylurea, except that the sulfonylurea-treated group had slightly higher BG values at 120 minutes. Postprandial blood glucose values were high in insulin-treated diabetic patients, but the more daily injections the patients received, the lower was the BG. Blood glucose decline was observed earlier when patients were given an injection of short-acting insulin just before the meal. These results were confirmed in an additional study of sixteen patients who were tested three times with the three kinds of insulin treatment.Comparison with nondiabetic subjects may facilitate identification of criteria for control of diabetes in the postprandial state both with and without insulin treatment. This study also indicates that with any of the treatments some diabetic subjects may have postprandial glucose homeostasis similar to that of nondiabetic subjects. DIABETES 22: 834-46, November, 1973.
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