Effect of subcutaneous insulin detemir on glucose flux and lipolysis during hyperglycaemia in people with type 1 diabetes

• Published in: Diabetes, obesity & metabolism obesity & metabolism, 2015-05, Vol.17 (5), p.459-467
• Main Authors: Herring, R. A., Shojaee-Moradie, F., Umpleby, A. M., Jones, R., Jackson, N., Russell-Jones, D. L.
• Format: Article
• Language: English
• Subjects: Adult; Blood Glucose - biosynthesis; Blood Glucose - drug effects; Blood levels; Body Mass Index; Body weight; Diabetes; Diabetes mellitus (insulin dependent); Diabetes Mellitus, Type 1 - drug therapy; Glucose; Glucose metabolism; Glycated Hemoglobin A; Glycerol; Glycerol - blood; Hemoglobin; Humans; Hyperglycemia; Hyperglycemia - drug therapy; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - pharmacology; Injections, Subcutaneous; Insulin; insulin analogues; Insulin Detemir - administration & dosage; Insulin Detemir - pharmacology; insulin therapy; Insulin, Isophane - pharmacology; Isotopes; Lipid metabolism; Lipolysis; Lipolysis - drug effects; liver; Male; type 1 diabetes
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.12434

Aims To investigate, using a novel non‐steady‐state protocol, the differential effects of subcutaneous (s.c.) detemir and NPH insulin on glucose flux and lipid metabolism after insulin withdrawal. Methods After a period of insulin withdrawal resulting in whole‐blood glucose concentration of 7 mmol/l, 11 participants (five men, mean age 41.0 years, mean body mass index 25 kg/m2) with type 1 diabetes (mean glycated haemoglobin concentration 57 mmol/mol, mean diabetes duration 14 years) received 0.5 units per kg body weight s.c. insulin detemir or NPH insulin in random order. Stable isotopes of glucose and glycerol were infused intravenously throughout the study protocol. Results Glucose concentration decreased after insulin treatment as a result of suppression of endogenous glucose production, which occurred to a similar extent with both detemir and NPH insulin. The rate of glucose disappearance (Rd) was not increased significantly with either type of insulin. When the effect of detemir and NPH insulin on glucose flux at glucose concentrations between 9 and 6 mmol/l was examined, glucose rate of appearance (Ra) was similar with the two insulins; however, glucose Rd was greater with NPH insulin than with detemir at glucose concentrations of 8.0, 8.5, 7.0 and 6.0 mmol/l (p