A six-minute test with glucagon-free insulin as a guide to treatment of diabetes.

Abstract

In the treatment of diabetes, the ability of the organism to respond to insulin has not been accorded the attention it merits. This is especially true since it has been demonstrated that in normal individuals responsiveness to insulin is largely contingent on dietary habits. Therapeutic efforts have been centered about attaining a reasonably “normal” blood glucose level, whatever may be the method of arriving at this quasi-ideal state. Spot blood glucose readings have been the basis for determining such “normalcy”. Certainly, in the diabetic these isolated readings do not necessarily reflect a true picture of the status of insulin function. They can at best present only snapshots of blood glucose status at given instants rather than a dynamic picture of what is actually happening to a function which is probably never static. They portray the end result of an action rather than the mechanism of the action producing it. For example, a patient receiving insulin who shows a blood glucose value of 130 or more mg. per 100 cc. may be in far better glucose economy than is one with a value of only 80 mg. The latter's supernormal level may well represent an artifact of normal suggesting improved insulin efficiency in the individual, a picture which, however, is not at all dependent on improved intrinsic insulin function but rather on a forced and unphysiologic lowering of blood sugar resulting from massive dosage of extrinsic insulin. The ideal reading may well represent a mass stoicheiometric effect of insulin from without rather than the more normal functional role of the hormone, which should act as a delicate and sensitive catalyst even in small dosage.