Patients with malnutrition related diabetes mellitus are as insulin sensitive as insulin dependent diabetics.

ABSTRACT

OBJECTIVES: High insulin requirement is considered as indicative of insulin resistance in malnutrition related diabetes mellitus (MRDM). Hyperinsulinemic euglycemic clamp technique (HECS) is the gold standard to assess insulin sensitivity in vivo. Hence we carried out HECS in a group of MRDM and compared it to subjects with insulin dependent diabetes mellitus (IDDM) to assess whether patients with malnutrition related diabetes mellitus have lower insulin mediated glucose disposal than IDDM. METHODS: In a case control design insulin mediated glucose disposal assessed by HECS at insulin infusion rate of 40 mU/m2 during steady state of 60-120 minutes. Mean coefficient of variation of plasma glucose during 60-120 minute steady state was 3.58 +/- 0.33 mg%. Whole body glucose disposal rate ("M" value) was expressed in mg/kg/min, which was equal to the glucose infused under steady state plasma glucose concentration during last one hour of HECS. RESULTS: Insulin mediated glucose disposal was measured in MRDM and compared with ketosis prone diabetes of young (IDDM) by HECS. Both groups were matched for age (23.4 +/- 1.8 vs. 19.8 +/- 2.5 years) and BMI (16.7 +/- 0.6 vs. 18.5 +/- 0.6 kg/m2). They were also comparable in duration of illness (4.4 +/- 1.0 vs. 4.5 +/- 1.0 years) and WHR (0.87 +/- 0.02 vs. 0.83 +/- 0.02). Patients in both groups had comparable glycemic control (HbAl 12.1 +/- 0.54 vs. 10.5 +/- 1.2), serum cholesterol (145 +/- 11 vs. 167 +/- 21 mg/dl) and serum triglyceride levels (147 +/- 13 vs. 110 +/- 9 mg/dl). Glucose disposal rate (M-value, mg/kg/min) during 60-120 minutes (7.06 +/- 0.80 vs. 7.50 +/- 0.87) and during 100-120 minutes (7.76 +/- 0.96 vs. 7.75 +/- 1.25) was not different in the two groups. CONCLUSIONS: High insulin requirement considered as indicative of insulin resistance in atypical ketosis resistant young diabetics is not due to insulin resistance.