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Effect of Overnight Restoration of Euglycemia on Glucose Effectiveness in Type 2 Diabetes Mellitus¹

Division of Endocrinology, Metabolism, and Nutrition, Mayo Clinic (R.B., A.B., P.S., R.A.R.), Rochester, Minnesota 55905; Aarhus Kommunehospital (M.N.), Aarhus, Denmark

Address all correspondence and requests for reprints to: Dr. Robert A. Rizza, 200 First Street SW, 5–194 Joseph, Rochester, Minnesota 55905. E-mail: rizza.robert{at}mayo.edu

The ability of glucose to stimulate its own uptake and suppress its own release is impaired in type 2 diabetes. To determine whether glucose effectiveness is improved by short term euglycemia, 10 type 2 diabetic subjects were studied on 2 occasions. Insulin was infused throughout the night to maintain euglycemia (5 mmol/L), or glucose was permitted to remain at ambient hyperglycemic levels (10 mmol/L) until the following morning when euglycemia was achieved with a variable insulin infusion. A prandial glucose infusion (containing 35 g glucose) was started at 1000 h, and the variable insulin infusion was replaced by a constant infusion of insulin (0.25 mU/kg·min), somatostatin (60 ng/kg·min), glucagon (0.65 ng/kg·min), and GH (3 ng/kg·min) to maintain hormone concentrations at constant basal levels. Although nocturnal glucose concentrations were (by design) higher (P < 0.01) on the hyperglycemic than on the euglycemic study day (10.1 ± 0.2 vs. 5.4 ± 0.1 mmol/L), glucose concentrations did not differ either before (4.9 ± 0.1 vs. 4.9 ± 0.1 mmol/L) or during the prandial glucose infusion (peak, 11.1 ± 0.5 vs. 11.3 ± 0.5 mmol/L; incremental area, 1390 ± 254 vs. 1409 ± 196 mmol/L·6 h). Furthermore, glucose-induced stimulation of glucose disappearance (2068 ± 218 vs. 1957 ± 244 µmol/kg·6 h) and suppression of glucose production (-2253 ± 378 vs. -2124 ± 257 µmol/kg·6 h) did not differ. Thus, restoration of euglycemia by means of an overnight insulin infusion does not alter glucose effectiveness in people with type 2 diabetes.

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