Reduced Glucose Tolerance in Elderly Human Subjects

Abstract

The high incidence of “abnormal” oral glucose tolerance tests in “normal” subjects over seventy years of age has been confirmed: 77 per cent in this series of individuals. Calculation of glucose disposal rates (GDR's) after three successive intravenous injections of glucose (25 gm.) in fifteen elderly normal subjects revealed GDR's which rose with successive injections, and which were significantly inferior to those observed in young adult normal subjects, yet significantly superior to the findings in patients with tolbutamide-responsive diabetes mellitus. Serum levels of insulin-like activity (ILA) assayed on the rat epididymal fat pad were higher in the elderly than in the young normal subjects both in the fasting state and after the first and third glucose injections. It is concluded that the abnormal tolerance of elderly subjects to an oral load of glucose is not due to retarded absorption of the administered glucose nor to impaired pancreatic secretion of insulin, but presumably results from a higher level of circulating insulin antagonist or from some other cause of delayed glucose uptake from the plasma. The present difficulties in diagnosing diabetes in elderly subjects have been pointed out, and possible means of differentiating between normal and diabetic individuals at all ages have been discussed.

Obesity Due to the Syndrome of Narcolepsy and Diabetogenic Hyperinsulinism: Clinical and Therapeutic Observations on 252 Patients*

“…1) These findings are consistent with the writer's belief that diabetes mellitus basically represents "high-output failure" ("decompensation," "exhaustion") of insulinogenesis (10). This hypothesis is also supported by the results of plasma insulin and insulin-like activity assays, the comparative responses to intravenous tolbutamide (1.0 gm) during the morning and the afternoon (10), and the data of others (13).…”

“…2), this reversed pattern appeared to be permanent, i.e., it was not affected by daytime recumbency, diuretic therapy, cessation of smoking, surgical castration, dietary modification, season of the year, or dexamethasone therapy. During treatment with synthetic oxytocin (Syntocinon ) , either by injection (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) or nasal spray, the diurnal volume pattern became normal or nearly normal (reproducibly) in all but 2 patients, generally with symptomatic improvement (8).…”

Influence of Ageing on Glucose Homeostasis*

“…There is general agreement, however, that the insulin response to glucose and insulinglucagon relationships do not change appreciably with age (1,2). Furthermore, since both oral and iv glucose tolerance are similarly affected by age, changes in absorption are unlikely to play a major role (1,(3)(4)(5)(6). Previous authors (7,8) have studied tissue responsiveness to insulin and glucose disposal using the hyperglycemic and euglycemic clamp techniques but their conclusions are conflicting.…”

Reproductibilité de la mesure de la Glycémie chez le sujet âgé

“…Cette augmentation porte essentiellement sur H2 alors que Ho se modifie peu [13,14]. Les chiffres moyens que nous avons observés dans notre groupe de vieillards sont parfaitement compatibles avec les données de la littérature, notamment avec la droite de régression Hz-âge donnée par Lazarovici et al [10].…”