[Insulin therapy of obese diabetic patients? Consequences for the evaluation of insulin secretion and metabolic behavior].

Abstract

Unlabelled: In 83 diabetics insulin secretion was examined after a mean diabetes duration of 7.5 years, when an insufficient metabolic situation could be found. Insulin secretion was stimulated with 100 g glucose (orally) and 1.0 mg glucagon i.v. (60 min after glucose intake). We investigated additionally in a retrospective manner blood-glucose and urine glucose behaviour as well as the development of the body weight. In dependence of the actual body weight at the time of investigation of insulin secretion, two groups were formed: b. w. less than 120% acc. Broca index, group A, n = 38; b. w. greater than 120% acc. Broca index. group B, n = 45). Immediately after manifestation of the disease 71 diabetes were treated with pure dietetic measures. At the examination of insulin secretion all patients were treated with glibenclamide. After this examination in 20 patients of the group A and in 17 patients of the group B an insulinisation was started. In the others glibenclamide treatment was continued. The general characteristics of the whole group was a significant reduction of the maximum stimulability of insulin secretion, compared with the insulin secretion of n = 19 healthy probands (11 probands with normal body weight and 8 obese probands). A hyperinsulinism (maximum values higher than mean + 1 s of the health persons) could not be found in any case. The mean of the maximum insulin values was below mean - 1 s of the healthy persons. Insulinisation provoked an improvement of the metabolic situation. This was correlated with an additional improvement of the subjective behaviour.

Conclusion: Evaluation of insulin secretion in obese diabetics with bad metabolic situation is necessary to find out those who are to be treated with insulin. We have no clinical or other possibilities to recognize patients with a hyperinsulinism or reduced insulin secretion than by evaluation of insulin secretion alone. But higher degrees of decompensated metabolism are nearly always explained by a significant reduction of insulin secretion.