Free insulin, bound insulin, C‐peptide and the metabolic control in juvenile onset diabetics: comparison of C‐peptide secretors and non‐secretors during 24 hours conventional insulin therapy

Gerbitz, Klaus-Dieter; Kemmler, Wolfgang; Edelmann, Abraham; Summer, J.; Mehnert, Hellmut; Wieland, O.

doi:10.1111/j.1365-2362.1979.tb00916.x

Cited by 16 publications

(11 citation statements)

References 56 publications

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“…A significant inverse correlation was found between C-peptide and the degree of glycaemic control, as expressed by diurnal mean blood glucose and mean amplitude of glycaemic excursions (MAGE) in patients with the same duration of disease [21]. Comparable results have been obtained in patients with longer durations of disease [35,56,60,61].…”

Section: Metabolic Importance Of Residual B Cell Function At Diagnosimentioning

confidence: 49%

“…Several studies have correlated B cell function and insulin-binding antibodies [27,35,[56][57][58] and, except for one study, no significant correlations have been found [35]. In that study the highest titres of antibodies were found in the group without B cell function, but these patients had also had diabetes for longer and were younger at onset.…”

Section: Immune Mechanisms In Relation To B Cell Functionmentioning

confidence: 80%

“…In patients with diabetes for less than 5 years, diurnal profiles of C-peptide were highly correlated with plasma glucose [21,30,56,[59][60][61][62][63]. Also, during insulin-induced hypoglycaemia, B cells were sensitive to changes in glucose below the normal range [63].…”

Section: Qualitative Function Of Residual B Cells In Insulin-dependenmentioning

confidence: 99%

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Prevalence of residual B cell function and its metabolic consequences in Type 1 (insulin-dependent) diabetes

Madsbad¹

1983

Diabetologia

103

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Summary. Several reports suggest that most patients have surviving B cells at the onset of Type 1 (insulin-dependent) diabetes. After starting insulin therapy, most have a transient improvement in B cell function which peaks between 2 and 6 months after diagnosis. Thereafter B cell function declines. However, even after 2 years most patients still display some residual B cell function. During the following 10-15 years, the prevalence of residual B cell function decreases to about 15% and stays at this level. At present it is unknown why patients with Type 1 diabetes have different degrees of B cell function after several years of disease. Age at onset is of importance for the first 10-15 years of disease. Patients with late onset have a higher prevalence of retained B cell function than patients with early onset. Both at the onset of disease and after the initial remission period, an improvement in glycaemic control results in improved B cell function but the effect is transient. The occurrence of islet cell antibodies, islet cell surface antibodies and the many abnormal cellular immunological parameters found in Type 1 patients have not been correlated to the degree of B cell function. The metabolic importance of even minimal endogenous insulin secretion on intermediate metabolism has been clearly demonstrated during insulin withdrawal. During hypoglycaemia, patients with B cell function have a greater glucagon and pancreatic polypeptide response than patients without. The nadir and recovery of blood glucose do not differ, but rates of lipolysis and ketogenesis are exaggerated in those without B cell function. Residual B cell function is clearly linked to clinical remission but seems to have little effect on metabolic control in daily life after years of diabetes. Only patients with considerable B cell function have markedly better metabolic control than patients without B cell function, but those with residual B cell function need a smaller daily dose of insulin to obtain the same degree of control. Whether residual B cell function protects against or delays the development of late complications is not clear.

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Section: Metabolic Importance Of Residual B Cell Function At Diagnosimentioning

confidence: 49%

Section: Immune Mechanisms In Relation To B Cell Functionmentioning

confidence: 80%

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Prevalence of residual B cell function and its metabolic consequences in Type 1 (insulin-dependent) diabetes

Madsbad¹

1983

Diabetologia

103

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“…In newly diagnosed, untreated patients with IDDM the peripheral and portal insulin concentrations are, of course, severely reduced. During subcutaneous insulin therapy of IDDM a peripheral hyperinsulinemia is established (23). However, despite a higher insulinemia in peripheral arteries, these diabetics do not have the level of portal vein insulin concentration of normal subjects.…”

Section: Regulation Of Glucose Homeostas1smentioning

confidence: 97%

Insulin Resistance and Insulin-Dependent Diabetes Mellitus

Pedersen

Beck‐Nielsen

1987

Diabetes Care

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“…In some studies no better metabolic control was found in patients in whom Cpeptide could be demonstrated [1,2]. Other authors have reported a positive correlation between the degree of metabolic control and C-peptide levels in groups of patients [3][4][5][6][7][8], but in individual patients this relationship was not always present. In almost all studies C-peptide immunoreactivity was measured by methods which include proinsulin bound to insulin antibodies.…”

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confidence: 99%

The relationship between residual insulin secretion and metabolic stability in Type 1 (insulin dependent) diabetes

1981

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Summary. The purpose of this study was to investigate whether the great differences in metabolic control between labile and stable insulin dependent juvenile diabetics could be explained by differences in residual pancreatic Bcell function. Nine labile diabetics, ten stable diabetics on one insulin injection a day and nine stable diabetics on two insulin injections a day were investigated during a 24-h period during which they maintained their usual diet and insulin therapy. Serum C-peptide concentrations were measured after removal of proinsulin bound to insulin antibodies. The labile diabetics did not show any significant change in C-peptide concentrations despite great fluctuations in plasma glucose concentrations. In six patients with stable diabetes, C-peptide responses after the main meals could be demonstrated and there was a significant correlation between the concentrations of C-peptide and glucose (r = 0.85, p < 0.001). The other stable patients, having the same mean plasma glucose concentration and mean amplitude of glycaemic excursions, did not show any C-peptide response. It is concluded that persistent insulin secretion is not a prerequisite for metabolic stability. Severe lability, however, seems to occur only in the absence of residual insulin secretion.Key words: Type 1 diabetes, labile and stable diabetes, radioimmunoassay of C-peptide, serum Cpeptide levels, plasma glucose levels.The significance of residual insulin secretion, established by the measurement of serum C-peptide levels, for the degree of metabolic control in Type 1 diabetes is not clear. In some studies no better metabolic control was found in patients in whom Cpeptide could be demonstrated [1,2]. Other authors have reported a positive correlation between the degree of metabolic control and C-peptide levels in groups of patients [3][4][5][6][7][8], but in individual patients this relationship was not always present. In almost all studies C-peptide immunoreactivity was measured by methods which include proinsulin bound to insulin antibodies. Moreover the measurements were performed in the fasting state or after non-physiological stimuli. In the present study C-peptide was measured after the removal of insulin antibodies in diabetics with stable and labile diabetes during the patients' usual diet and insulin therapy. The aim of the study was to investigate whether the great variation in metabolic stability could be explained by differences in residual insulin secretion. Patients and Methods PatientsAll patients were Type I (insulin dependent) diabetics, selected as labile or stable patients on the basis of previously established criteria.The diabetes was considered as labile if all of the following criteria during one year before the start of the study were fulfilled: (1) mean glycosuria >30g/24h; (2) the occurrence of high (>20 mmol/1) and low (<10 retool/l) plasma glucose concentrations at the same time on different days; (3) ketonuria (+ + or + + +) with high glycosuria on at least three visits, without intercurrent illness; (4)...

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Free insulin, bound insulin, C‐peptide and the metabolic control in juvenile onset diabetics: comparison of C‐peptide secretors and non‐secretors during 24 hours conventional insulin therapy

Cited by 16 publications

References 56 publications

Prevalence of residual B cell function and its metabolic consequences in Type 1 (insulin-dependent) diabetes

Prevalence of residual B cell function and its metabolic consequences in Type 1 (insulin-dependent) diabetes

Insulin Resistance and Insulin-Dependent Diabetes Mellitus

The relationship between residual insulin secretion and metabolic stability in Type 1 (insulin dependent) diabetes

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