The effect of 'low-dose' (6-10 U/h) insulin treatment on the rate of decline of plasma glucose concentration was determined in 15 diabetic subjects admitted in ketoacidosis (plasma glucose = 948 ± 79 mg/dl) and in six normal volunteers rendered hyperglycemic by a combined infusion of somatostatin and glucose (plasma glucose = 653 ± 28 mg/dl). The fractional glucose turnover and the half-time of the fall in plasma glucose during insulin treatment were both 10-fold reduced (P <0.001) in the diabetics as compared with the controls. In the ketoacidotic subjects, the mean glucose clearance during insulin treatment was only 8% of that in the controls (P <0.001). In the normal subjects, tissue glucose clearance during insulin treatment of the hyperglycemia (5.8 ± 0.7 ml/min . kg) was similar to that measured in the same subjects using a standard technique to quantitate insulin sensitivity (euglycemic insulin clamp). In the ketoacidotic patients, a history of prior insulin therapy, but not the degree of hyperglycemia at te time of admission, was associated with a more rapid rate of decline of plasma glucose in response to insulin treatment. We conclude that marked insulin resistance is present in virtually all diabetics in ketoacidosis.
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism