Diurnal pattern to insulin secretion and insulin action in healthy individuals

Diabetes. 2012 Nov;61(11):2691-700. doi: 10.2337/db11-1478. Epub 2012 Jun 29.

Abstract

Evaluation of the existence of a diurnal pattern of glucose tolerance after mixed meals is important to inform a closed-loop system of treatment for insulin requiring diabetes. We studied 20 healthy volunteers with normal fasting glucose (4.8 ± 0.1 mmol/L) and HbA(1c) (5.2 ± 0.0%) to determine such a pattern in nondiabetic individuals. Identical mixed meals were ingested during breakfast, lunch, or dinner at 0700, 1300, and 1900 h in randomized Latin square order on 3 consecutive days. Physical activity was the same on all days. Postprandial glucose turnover was measured using the triple tracer technique. Postprandial glucose excursion was significantly lower (P < 0.01) at breakfast than lunch and dinner. β-Cell responsivity to glucose and disposition index was higher (P < 0.01) at breakfast than lunch and dinner. Hepatic insulin extraction was lower (P < 0.01) at breakfast than dinner. Although meal glucose appearance did not differ between meals, suppression of endogenous glucose production tended to be lower (P < 0.01) and insulin sensitivity tended to be higher (P < 0.01) at breakfast than at lunch or dinner. Our results suggest a diurnal pattern to glucose tolerance in healthy humans, and if present in type 1 diabetes, it will need to be incorporated into artificial pancreas systems.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Blood Glucose / analysis
  • Carbon Isotopes
  • Circadian Rhythm*
  • Cohort Studies
  • Cross-Over Studies
  • Deuterium
  • Female
  • Gluconeogenesis
  • Glucose / metabolism*
  • Glucose Intolerance / blood
  • Glucose Intolerance / metabolism
  • Humans
  • Insulin / blood
  • Insulin / metabolism*
  • Insulin Resistance*
  • Insulin Secretion
  • Insulin-Secreting Cells / metabolism*
  • Male
  • Middle Aged
  • Postprandial Period
  • Young Adult

Substances

  • Blood Glucose
  • Carbon Isotopes
  • Insulin
  • Deuterium
  • Glucose