Topic
Insulin
About: Insulin is a research topic. Over the lifetime, 124295 publications have been published within this topic receiving 5129734 citations. The topic is also known as: human insulin.
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TL;DR: The effects of a strict low-carbohydrate diet, which included the diet supplements recommended by Dr. Atkins, on energy intake and expenditure, body weight and body water, glucose metabolism, and insulin sensitivity in obese patients with type 2 diabetes in the controlled environment of a clinical research center are determined.
Abstract: In a small group of obese, diabetic patients, 2 weeks of a low-carbohydrate diet led to spontaneous reduction in energy intake because, despite the carbohydrate restriction, the participants did no...
501 citations
TL;DR: The results indicate that under the conditions studied, insulin and C-peptide aresecreted in equimolar concentrations in man, and that proinsulin is secreted in the same proportion to insulin as found in the pancreas.
Abstract: Concentrations of insulin, proinsulin, and C-peptide were measured in portal and peripheral venous blood in six nondiabetic, nonobese subjects. Portal vein samples were obtained by umbilical vein catheterization. Three subjects were studied with intravenous infusion of 25 g glucose, and three with 30 g arginine. Insulin and proinsulin were determined in the insulin immunoassay after separation by gel filtration, and C-peptide was measured by direct immunoassay. With both glucose and arginine stimulation, portal vein levels of all three peptides peaked at 90-120 s after the onset of the stimulus. Relative increases in insulin concentration were greater than those of proinsulin or C-peptide. In peripheral venous blood, maximal levels of the three peptides were observed later (2-5 min), and the increase in insulin relative toproinsulin and C-peptide was not as great. At the time of peak secretion, portal vein insulin and C-peptide approached equimolar concentrations, and proinsulin, as measured against an insulin standard, comprised approximately 2.5% of the total immunoreactive insulin. After stimulation by glucose or arginine, portal insulin, proinsulin and C-peptide levels were not correlated with the concentrations measured in simultaneously drawn peripheral samples. At all sampling times, however, significant correlation was found between insulin and C-peptide in both peripheral and portal blood. The results indicate that under the conditions studied, insulin and C-peptide are secreted in equimolar concentrations in man, and that proinsulin is secreted in the same proportion to insulin as found in the pancreas. Consideration of the relative secretory and metabolic rates of the three beta cell peptides explains their peripheral concentrations. The data further support the use of plasma C-peptide as an indicator of beta cell secretory function.
501 citations
TL;DR: A technique was devised for a more accurate measurement than has been heretofore possible of one of the factors responsible for hyperglycemia in the complex syndrome of diabetes, termed impedance, which represents the tissues' insensitivity or resistance to insulin-mediated glucose uptake.
Abstract: A technique was devised for a more accurate measurement than has been heretofore possible of one of the factors responsible for hyperglycemia in the complex syndrome of diabetes. This factor is termed impedance and represents the tissues' insensitivity or resistance to insulin-mediated glucose uptake. It was measured by use of steady-state exogenous insulin and glucose infusions during a period of pharmacological suppression of endogenous insulin secretion. Endogenous new glucose production was also inhibited. Impedance as calculated is a direct function of steady-state glucose concentrations, since exogenous insulin concentrations were similar in all studies. Two groups of normal weight subjects were studied. One had maturity onset latent diabetes, and the other (matched for age, weight, and per cent adiposity) was normal. Impedance was closely reproducible in the same individual and remained relatively constant during prolonged infusions. The diabetics had average infusion glucose concentrations (and thus impedance) 68% higher than the normal group, and it is of note that their previously measured glucose intolerance differed by a similar degree; that is, the diabetic's intolerance (as defined by mean weighted plasma glucose response after oral glucose) was 52% greater than that of the normal individuals.
501 citations
TL;DR: CHF is associated with marked insulin resistance, characterized by both fasting and stimulated hyperinsulinemia, but this is not directly mediated through ventricular dysfunction or increased catecholamine levels.
501 citations
TL;DR: Physiologic insulin therapy with insulin analogues is now relatively simple to use and is associated with fewer episodes of hypoglycemia, especially when started early in the course of disease.
Abstract: ContextNewer insulin therapies, including the concept of physiologic basal-prandial
insulin and the availability of insulin analogues, are changing clinical diabetes
care. The key to effective insulin therapy is an understanding of principles
that, when implemented, can result in improved diabetes control.ObjectiveTo systematically review the literature regarding insulin use in patients
with type 1 and type 2 diabetes mellitus (DM).Data SourcesA MEDLINE search was performed to identify all English-language articles
of randomized controlled trials involving insulin use in adults with type
1 or type 2 DM from January 1, 1980, to January 8, 2003. Bibliographies and
experts were used to identify additional studies.Study Selection and Data ExtractionStudies were included (199 for type 1 DM and 144 for type 2 DM, and
38 from other sources) if they involved human insulins or insulin analogues,
were at least 4 weeks long with at least 10 patients in each group, and glycemic
control and hypoglycemia were reported. Studies of insulin-oral combination
were similarly selected.Data SynthesisTwenty-eight studies for type 1 DM, 18 for type 2 DM, and 48 for insulin-oral
combination met the selection criteria. In patients with type 1 DM, physiologic
replacement, with bedtime basal insulin and a mealtime rapid-acting insulin
analogue, results in fewer episodes of hypoglycemia than conventional regimens.
Rapid-acting insulin analogues are preferred over regular insulin in patients
with type 1 DM since they improve HbA1C and reduce episodes of
hypoglycemia. In patients with type 2 DM, adding bedtime neutral protamine
Hagedorn (isophane) insulin to oral therapy significantly improves glycemic
control, especially when started early in the course of disease. Bedtime use
of insulin glargine results in fewer episodes of nighttime hypoglycemia than
neutral protamine Hagedorn regimens. For patients with more severe insulin
deficiency, a physiologic insulin regimen should allow lower glycemic targets
in the majority of patients. Adverse events associated with insulin therapy
include hypoglycemia, weight gain, and worsening diabetic retinopathy if hemoglobin
A1C levels decrease rapidly.ConclusionsMany options for insulin therapy are now available. Physiologic insulin
therapy with insulin analogues is now relatively simple to use and is associated
with fewer episodes of hypoglycemia.
501 citations