Diabetes in Remission: Insulin Secretory Dynamics

Abstract

Insulin secretory capacity and sensitivity to exogenous insulin were examined in eight nonobese, ketosis-prone young diabetics at the time of a clinical remission during which they could be managed without any insulin therapy. The insulin secretory capacity of these patients was assessed with oral glucose, intravenous glucose and an oral mixed meal test. The insulin responses were variable and relatively subnormal compared to those in normal controls, but definite and substantial responses were found in the majority of the patients to all the stimuli. When small amounts of crystalline insulin were administered intravenously to produce peripheral venous insulin levels in the physiologic range, these patients responded with a normal decrease in blood glucose and plasma free fatty acid levels suggesting maintenance of in vivo insulin sensitivity. Since ketosis-prone, insulin-dependent diabetics are generally characterized by nearly complete failure of beta-cell function, the present finding supports the concept that clinical remission of diabetes is dependent on a functional recovery of the beta cell. Furthermore, it seems likely that no significant “insulin resistance” that often accompanies severe diabetes is present in this remission state.