Summary
Two main methods are available for assessing insulin sensitivity with the hyperinsulinaemic euglycaemic clamp technique: one employs a glucose-controlled insulin infusion system (the Biostator) with automatic feedback control; the second depends on frequent glucose measurement and the use of an algorithm and a pocket calculator (‘manual’) to determine the glucose infusion rate. The amount of glucose infused is a measure of insulin sensitivity. The efficiency of the two methods was compared in nine normal subjects (seven lean, two obese). After an overnight fast subjects were infused with insulin at 50 mU · kg-1 · h-1 for 2 h; this rate was doubled during the first 10 min for the manual technique. Blood glucose averaged 4.7 ± 0.1 and 4.8 ± 0.1 mmol/l from 0 to 120 min for Biostator and manual techniques and did not deviate significantly from the desired level. Variability of the clamp was also similar over the same period (coefficient of variation 5.1 ±0.6% and 6.4 ±0.7%, Biostator and manual). Glucose infused to maintain steady state from 60 to 120 min was higher, however, with the manual than the Biostator method (5.7±0.6 versus 4.4 ± 0.6 mg·kg-1·min-1, p< 0.01) even when the loading dose was omitted, although the two methods correlated closely (p< 0.05). Glucose infusion rate varied more from minute to minute with the Biostator (coefficient of variation 28.8 ± 3% versus 12.2 ± 2.1%). Steady-state serum insulin levels (30–120 min) were the same during both methods. Thus both methods give effective clamping but the manual method is simpler and shows less variability in glu cose insulin infusion rate.
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References
DeFronzo RA, Tobin JD, Andres R (1979) Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol 237: E214–223
Home PD, Massi-Benedetti M, Shepherd GAA, Hanning I, Alberti KGMM, Owens D (1982) A comparison of the activity and disposal of semi-synthetic human insulin and porcine insulin in man by the glucose clamp technique. Diabetologia 22: 41–45
Massi-Benedetti M, Burrin JM, Capaldo B, Alberti KGMM (1981) A comparative study of the activity of E. coli-derived human insulin and porcine insulin using the glucose clamp technique in normal man. Diabetes Care 4: 163–167
Rizza R, Mandarino LJ, Gerich JE (1981) Mechanisms of insulin resistance in man. Assessment using the insulin dose-response curve in conjunction with insulin-receptor binding. Am J Med 70: 169–176
Olefsky J (1981) Insulin resistance and insulin action. An in vitro and in vivo perspective. Diabetes 30: 148–163
Verdonk CA, Rizza RA, Westland RE, Nelson RL, Gerich JE, Service JJ (1980) Glucose clamping using the Biostator GCIIS. Horm Metab Res 12: 133–135
Andres R, Swerddoff R, Pozefsky T, Coleman D (1966) Manual feedback technique for the control of blood glucose concentration. In: Skeggs LT (ed) Automation in analytical chemistry. Mediad, New York, pp 486–491
Diem K (ed) (1959) Desirable weight of adults, 6th edn. Documenta Geigy, Macclesfield, p 624
Abumrad N, Rabin D, Diamond M, Lacy W (1981) Use of heated superficial hand vein as alternative site for the measurement of aminoacid concentrations and for the study of glucose and alanine kinetics. Metabolism 30: 936–940
Lloyd B, Burrin JM, Smythe P, Alberti KGMM (1978) Simple automated fluorimetric assays for blood glucose, lactate, pyruvate, alanine, glycerol and 3-hydroxybutyrate. Clin Chem 24: 1724–1729
Soeldner J, Slone D (1965) Critical variables in the radioimmunoassay of serum insulin using the double antibody technic. Diabetes 14: 771–779
Heding LG (1975) Radioimmunological determination of human C-peptide in serum. Diabetologia 11: 541–548
Ørskov H, Thomsen HG, Yde H (1968) Wick chromatography for rapid and reliable immunoassay of insulin, glucagon and growth hormone. Nature 219: 193–195
Sacca L, Sherwin R, Hendler R, Felig P (1979) Influence of continuous physiologic hyperinsulinemia on glucose kinetics and counterregulatory hormones in normal and diabetic humans. J Clin Invest 63: 849–857
Olefsky JM, Kolterman OG (1981) Mechanisms of insulin resistance in obesity and non-insulin dependent (Type II) diabetes. Am J Med 70: 151–168
DeFronzo RA, Andres R, Bledsoe T, Boden G, Faloona GA, Tobsin TD (1977) A test of the hypothesis that the rate of fall in glucose concentration triggers counterregulatory hormonal responses in man. Diabetes 26: 445–452
Schade DS, Eaton RP (1977) Dose response to insulin in man: differential effects on glucose and ketone body regulation. J Clin Endocrinol Metab 44: 1038–1053
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Ponchner, M., Heine, R.J., Pernet, A. et al. A comparison of the artificial pancreas (glucose controlled insulin infusion system) and a manual technique for assessing insulin sensitivity during euglycaemic clamping. Diabetologia 26, 420–425 (1984). https://doi.org/10.1007/BF00262213
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DOI: https://doi.org/10.1007/BF00262213