PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 10752071

Pulsatile insulin secretion.

P Butler
View original source ↗Export metadata ↓

Abstract

Insulin is secreted in a pulsatile manner. Recently it has been shown that almost all (approximately 70-100%) of insulin is secreted in discrete insulin secretory bursts occurring approximately every 6 min. Furthermore, it has been revealed that regulation of the rate of insulin secretion is achieved primarily through modulation of the mass of these discrete insulin bursts. Thus meal ingestion increases insulin secretion by enhancing insulin burst mass by approximately 50% but also increases pulse frequency by approximately 50%. Interestingly, the hepatic clearance of insulin is also apparently closely related to the pattern of insulin delivery to the liver. It has been known for many years that the pattern of insulin delivery is abnormal in patients with type 2 diabetes. Recently, with new more sensitive insulin assays (ELISA) and validated methods for pulse detection, it has been possible to examine more precisely the abnormalities of pulsatile insulin in patients with type 2 diabetes. These recent studies suggest that the principal defect of insulin secretion is a deficient pulse mass of insulin with no changes in pulse frequency, and that this defect can be overcome by a period of beta cell rest.

Explore related subjects

Diabetes MellitusHumansInsulinJournal ArticleReview

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

P Butler. 2000. Pulsatile insulin secretion.. https://pubmed.ncbi.nlm.nih.gov/10752071/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2001

[Insulin therapy in the type 2 obese diabetic patient. Supplementing the deficit].

The aim of insulin therapy in obese type 2 diabetics is to achieve a near-normal glycemic serum sugar metabolism while avoiding any further increase in weight and hypoglycemia. A further aim is to achieve maximum flexibility in the patient's lifestyle. For this purpose, in addition to bedtime administration of HPH insulin aimed at achieving a morning blood sugar level of < 100 mg/dl, regular insulin or a rapid-acting insulin analog should be administered at mealtimes. Administration of NPH insulin during the day is not necessary in most overweight type 2 diabetics--since the residual capacity for endogenous insulin secretion is adequate--and should be applied only when a requirement has been confirmed (basal rate test). Through the additive administration of oral (metformin, acarbose), metabolic control can be improved and the insulin dose simultaneously reduced, with associated positive effects on the patient's weight. With the aim of lowering the roughly three-fold increase in cardiovascular mortality rate in type 2 diabetics, optimal antihyperglycemic control should be accompanied by optimal management of blood lipids (LDL < 100 mg/dl, HDL > 45 mg/dl, triglycerides < 150 mg/dl), and blood pressure (RR < 135/80 mm Hg).

Diabetes Mellitus↗
PubMed2001

Improving diabetes care in the primary healthcare setting: a randomised cluster trial in remote Indigenous communities.

OBJECTIVE: To evaluate a system for improving diabetes care in remote Indigenous communities. DESIGN: Randomised, unblinded cluster trial over one year (1 March to 29 February 2000). PARTICIPANTS AND SETTING: Primary healthcare staff in 21 primary healthcare centres in the Torres Strait and Northern Peninsula Area (NPA) Health Service District, north Queensland, and 678 people with diabetes, mostly Torres Strait Islanders. INTERVENTION: Diabetes recall system established at eight of the 21 sites, as well as staff training in basic diabetes care, regular phone calls from the project officer, a two-monthly newsletter and a mid-project workshop. MAIN OUTCOME MEASURES: Regular checks of weight, blood pressure, eye and foot care, serum lipid levels and glucose monitoring and control, urinary albumin to creatinine ratio and serum creatinine levels, and administration of recommended vaccines; hospitalisation in the previous 12 months. RESULTS: There was improvement in most measures at most sites, except for blood pressure monitoring and control, and vaccination status. Intervention sites showed greater improvement in most indicators than control sites (combined relative risk [RR], 1.21; 95% CI, 1.03-1.43). The intervention group showed a 32% reduction in hospital admissions for diabetes-related conditions over the study period (P=0.012). At follow-up, patients in intervention sites were 40% less likely to be hospitalised for a diabetes-related condition than those in control sites (RR, 0.60; 95% CI, 0.41-0.86; P=0.007). CONCLUSION: A simple recall system, managed by local healthcare workers and supported by a diabetes outreach service, achieved significant improvements in diabetes care and reduced hospitalisations in a high-risk population.

Diabetes Mellitus↗