Diurnal pattern of insulin action in type 1 diabetes implications for a closed-Loop system

Ling Hinshaw, Chiara Dalla Man, Debashis K. Nandy, Ahmed Saad, Adil E. Bharucha, James A. Levine, Robert A. Rizza, Rita Basu, Rickey E. Carter, Claudio Cobelli, Yogish C. Kudva, Ananda Basu

Research output: Contribution to journalArticle

70 Scopus citations

Abstract

We recently demonstrated a diurnal pattern to insulin action (i.e., insulin sensitivity [SI]) in healthy individuals with higher SI at breakfast than at dinner. To determine whether such a pattern exists in type 1 diabetes, we studied 19 subjects with C-peptide- negative diabetes (HbA1c 7.1±0.6%) on insulin pump therapy with normal gastric emptying. Identical mixed meals were ingested during breakfast, lunch, and dinner at 0700, 1300, and 1900 h in randomized Latin square of order on 3 consecutive days when measured daily physical activity was equal. The triple tracer technique enabled measurement of glucose fluxes. Insulin was administered according to the customary insulin:carbohydrate ratio for each participant. Although postprandial glucose excursions did not differ among meals, insulin concentration was higher (P < 0.01) and endogenous glucose production less suppressed (P <0.049) at breakfast than at lunch. There were no differences in meal glucose appearance or in glucose disappearance between meals. Although there was no statistical difference (P = 0.34) in SI between meals in type 1 diabetic subjects, the diurnal pattern of SI taken across the three meals in its entirety differed (P = 0.016) from that of healthy subjects. Although the pattern in healthy subjects showed decreasing SI between breakfast and lunch, the reverse SI pattern was observed in type 1 diabetic subjects. The results suggest that in contrast to healthy subjects, SI diurnal pattern in type 1 diabetes is specific to the individual and cannot be extrapolated to the type 1 diabetic population as a whole, implying that artificial pancreas algorithms may need to be personalized.

Original languageEnglish (US)
Pages (from-to)2223-2229
Number of pages7
JournalDiabetes
Volume62
Issue number7
DOIs
StatePublished - Jul 2013

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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    Hinshaw, L., Man, C. D., Nandy, D. K., Saad, A., Bharucha, A. E., Levine, J. A., Rizza, R. A., Basu, R., Carter, R. E., Cobelli, C., Kudva, Y. C., & Basu, A. (2013). Diurnal pattern of insulin action in type 1 diabetes implications for a closed-Loop system. Diabetes, 62(7), 2223-2229. https://doi.org/10.2337/db12-1759