Mean Fasting Serum Insulin Levels Research Articles

Higher oxidative stress and inflammation in obese compared to lean patients with type 2 diabetes mellitus

AimTo compare mRNA [messenger RNA] expression of RELA, NFκB1, TNF-α, IL-6 and MCP-1 in whole blood & serum Total Antioxidant status [TAS] in newly diagnosed lean and obese patients with T2DM. MethodsNewly diagnosed treatment naïve patients of T2DM were enrolled in this study. The patients were divided into two groups of 30 patients each, lean (BMI< 18.5 kg/m2) and obese (BMI >25 kg/m2) groups. mRNA expression of RELA, NFκB1, TNF-α, IL-6 and MCP-1 was measured by real time PCR. Serum TAS was measured using a commercially available kit. ResultsThere was a 2.7-fold increase in mRNA expression of RELA in obese group compared to the lean group. There was a 1.3-fold increase in mRNA expression of NFκB1, a 3.24-fold increase in mRNA expression of TNF-α, a 4.7-fold increase in mRNA expression of IL 6 and a 3.8-fold increase in mRNA expression of MCP-1 in obese group compared to the lean group. Mean fasting serum insulin levels were 16.07 ± 8.39 μIU/mL in the lean group and 27.11 ± 4.91μIU/mL in the obese group (p = 0.001). Mean TAS level was 5.39 ± 2.28 μM Trolox Equivalents in the obese group and 3.85 ± 3.33 μM Trolox Equivalents in the lean group (p = 0.001). ConclusionInflammation and OS is higher in obese patients of T2DM compared to lean patients of T2DM. This could be the result of excess adipokines production or resistance to the anti-inflammatory effects of insulin with multiple explanations. Our study suggests a difference in the pathogenic mechanism in lean patients when compared with obese T2DM patients.

Metabolic parameters in acne vulgaris: a case control study investigating fasting blood glucose and insulin levels in acne vulgaris

Background: Influence of diet and lifestyle on acne among Indian population. Objectives were to identify the clinico-epidemiological profile of patients with Acne vulgaris and to assess the fasting plasma glucose and serum insulin levels in Acne vulgaris patients and the controls and correlate them. Methods: This was a hospital-based case-control study conducted in the Department of Dermatology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore. Study included 60 cases of acne and 60 controls (age and sex matched), attending the outpatient department. After complete history, general physical, systemic and cutaneous examination, all cases were subjected to following investigation: fasting blood sugar and serum insulin levels. Results: Acne was common in the age group 18-24 yrs (70%). In almost half the patients the age of onset was between 12-18 yrs. Commonly observed site for acne was cheeks (83.3%), forehead (66.7%), nose (55%) and chin (41.7%). The risk of developing acne was 3.5 times more among smokers than non-smokers. The mean fasting blood sugar values of cases and controls when compared showed a statistically significant difference (p&lt;0.05). Our study did not find any statistically significant difference in fasting insulin levels between cases and controls. Conclusions: There was only significant difference in the Mean fasting blood glucose in cases as compared to controls. Mean fasting serum insulin level though found to be raised in cases compared to controls, does not prove statistical significance. Fasting plasma glucose was significantly raised in grade III acne as compared to other grades.

Decreased Insulin Secretion but Unchanged Glucose Homeostasis in Cadmium-Exposed Male C57BL/6 Mice.

Cadmium (Cd) is a well-known toxic metal element that is largely distributed in the environment. Cd causes toxicity to most organs. Accumulating evidence suggests that Cd exposure is associated with islet dysfunction and development of diabetes, but the association remains controversial. The aim of this study is to evaluate the possible effects of chronic Cd exposure on glucose metabolism in male C57BL/6 mice. Mice were intraperitoneally injected with CdCl2 solution (1 mg.kg−1) twice a week for 24 weeks. Fasting blood glucose (FBG) levels and body weights were measured weekly. After 24 weeks, the intraperitoneal glucose tolerance test (IPGTT), intraperitoneal insulin tolerance test (IPITT), and fasting serum insulin (FSI) level test were performed. The insulin resistance index (HOMA-IR) and pancreatic β cell function index (HOMA-β) were calculated and analyzed. The expression of insulin receptor (IR) in mouse liver was detected by real-time PCR. Pancreatic tissue was collected for histological examination. The results demonstrated that FBG, IPGTT, HOMA-IR, and HOMA-β were identical between Cd exposure and control mice. In contract, mean fasting serum insulin level, area under the curve (AUC) of IPITT, and IR expression in livers of Cd-exposed mice decreased significantly compared with control mice. Cd administration induced islet atrophy and decreased islet area. The results suggested that Cd exposure decreased insulin secretion and maintained glucose homeostasis in male C57BL/6 mice and that pancreatic functions should be monitored in populations chronically exposed to Cd.

Insulin resistance as a predictor of sensory neuropathy in prediabetes

Objective: The aim of this study is to assess the association of insulin resistance with sensory neuropathy in prediabetes. Materials and Methods: Fasting serum insulin levels were measured and the homeostatic model assessment of insulin resistance (HOMA-IR) was calculated in all patients. These were compared in prediabetic patients having sensory neuropathy to those who did not have sensory neuropathy as determined by vibration perception thresholds (VPTs) measured using Digital Biothesiometer. Furthermore, direct correlation between insulin resistance and VPTs was checked. Results: A total of 60 prediabetic cases were included in this study. Among the study population, the age distribution ranged from 35 years to 60 years with the mean age of 48.68 years. Male and female formed 65% and 35% of the study population, respectively. The maximum fasting serum insulin levels were 21.8 mIU/L, and the minimum fasting serum insulin levels were 3.5 mIU/L, with the mean value being 10.61 ± 4.99 mIU/L. The maximum HOMA-IR was 6.4, and the minimum was 0.986, with the mean value being 2.81 ± 1.37. Among all the prediabetic patients, 43.3% of patients had neuropathy according to VPTs measured using Biothesiometer. T-test analysis suggests that mean fasting serum insulin levels (P = 0.026) and HOMA-IR (P = 0.032) were significantly higher in patients with neuropathy than patients without neuropathy. VPTs were found to have statistically significant positive correlation with fasting serum insulin levels (Pearson correlation coefficient = 0.317 [R], 0.296 [L];P = 0.013 [R], 0.022 [L]) and HOMA-IR (Pearson correlation coefficient = 0.299 [R], 0.281 [L];P = 0.02 [R], 0.03 [L]). Conclusion: Insulin resistance, quantified with the help of the index, HOMA-IR, has an important role in the development of this sensory neuropathy.

To study the prevalence of insulin resistance in non-diabetes hypertensive subjects

Background: Hypertension is an important medical and public health problem in both developed and developing countries. It is an important risk factor for morbidity and mortality from coronary heart disease, stroke and renal disease. It is well recognized that hypertension coexists in varying degrees with conditions of obesity, insulin resistance/hyperinsulinemia and dyslipidemia, the interrelated metabolic disorders characteristic of metabolic syndrome.Methods: The study was carried out at Sri Guru Ram Das hospital, Amritsar, Punjab, India. A total of 150 patients were taken, out of which 75 were hypertensive and 75 healthy subjects more than 18 years of age were recruited. Serum insulin concentration was measured using a solid phase enzyme linked immunoassay based on the sandwich principle. Insulin resistance was determined by HOMA-IR (homeostasis model assessment of insulin resistance).Results: Statistically, the mean fasting serum insulin level was 17.09±8.17 μIu/ml in cases and 9.33±2.67μIU/ml in controls (reference range 2-25 μIU/ml); the difference was statistically significant (P &lt;0.001). The mean value of HOMA-IR in cases was 3.86±1.84 as compared with controls with mean HOMA -IR value of 2.01±0.62. This difference was statistically significant (P &lt;0.001).Conclusions: Essential hypertension is significantly associated with higher mean fasting insulin levels and insulin resistance. Hyperinsulinemia has a possible role in the pathophysiology of essential hypertension with insulin resistance being the likely predominant mechanism.

Role of insulin resistance in essential hypertension

Introduction Hypertension is a major health problem with widespread and sometimes devastating consequences. To confirm the role of insulin resistance and hyperinsulinemia in the pathogenesis of essential hypertension, many studies have been conducted. As no data in this regard are available from our part of the world, our study focuses onestablishing the role of insulin resistance and compensatory hyperinsulinemia in the hypertensive Kashmiri population. Materials and methods The study was carried out at a tertiary care hospital from December 2010 to October 2012. A total of 100 individuals aged above 18 years were recruited; 50 were newly detected cases of essential hypertension and 50 were age-matched and sex-matched normal healthy individuals. Serum insulin concentration was measured using an insulin electrochemiluminescence immunoassay. Insulin resistance was determined by HOMA-IR (homeostasis model assessment of insulin resistance). A comparison and contrast analysis of data was carried out using standard statistical methods. Results Statistically, the difference in mean fasting blood glucose between the two study groups was significant (P=0.0001). The mean fasting serum insulin level was 15.32±13.76 µU/ml in cases and 8.01±4.08 µU/ml in controls (reference range 2.6–24.9 µU/ml); the difference was statistically significant (P=0.001). The mean value of HOMA-IR in cases was 3.81±3.42 as compared with controls with a mean HOMA-IR value of 1.76±0.93. This difference was statistically significant (P=0.0001). Conclusion Essential hypertension is significantly associated with higher mean fasting insulin levels and insulin resistance. Hyperinsulinemia has a possible role in the pathophysiology of essential hypertension with insulin resistance being the likely predominant mechanism.

Relationship of serum fasting insulin with gonadotropins in infertile women

Background: Infertility has become a global health problem in the world wide affecting 8-10% of couple. It is also a matter of social injustice and inequality. Increase level of insulin has been implicated as a cause of infertility. Objective: To find out the association of fasting serum insulin level with gonadotropins in infertile women. Methods: This cross sectional study was conducted in the department of Physiology, Dhaka Medical College, Dhaka from July 2010 to June 2011. A total number of 150 female age ranged from 20 – 40 years were included in this study. Out of them100 infertile women were selected as study group (group B). Group B was subdivided into group B1 and B2. Group B1 consisted of 50 primary infertile women and group B2 consisted of 50 secondary infertile women. Rest 50 age matched apparently healthy parous women were considered as base line control group A. All the study subjects were selected from out patient department of infertility unit, BSMMU, Dhaka. The control subjects were selected by personal contact. Serum fasting insulin was measured by enzyme-link-immunosorbend assay. Fasting blood glucose and blood glucose two hours after breakfast were measured by glucose oxidase method. The Data were collected in a prescribed data sheet after taking written consent. Statistical analyses were done by unpaired students “t” tests by SPSS program version 12. The level of significance was calculated and p value &lt;0.05 was accepted as level of significance. Results: In this study, the mean fasting serum insulin level were significantly higher in infertile women than those of fertile women (p&lt;0.001). Within the study group serum fasting insulin was higher in primary infertile women than that of secondary infertile women both were statistically not significant. Again, serum FSH and LH levels were significantly lower (P&lt;.0001) in infertile women than those of fertile women. But serum FSH level was lower and LH level was higher in primary infertile women than that of secondary infertile women. In addition, fasting blood glucose level was almost similar but within normal limits in all groups. Blood glucose 2HABF was significantly higher in secondary infertile women than that of fertile women but within in normal limit. Moreover, fasting serum insulin level was negatively correlated with serum FSH and LH in primary infertility but negatively correlated with serum FSH and positive correlation with serum LH in secondary infertility. Conclusion: From the above study it may be concluded that fasting serum insulin level was higher in infertile women than those of healthy fertile women. These alterations may lead to menstrual irregularities, ovulatory dysfunction and infertility. http://dx.doi.org/10.3329/bjpp.v29i1-2.20063 Bangladesh J Physiol Pharmacol 2013; 29(1&amp;2) : 17-24

Recent population changes in HbA1c and fasting insulin concentrations among US adults with preserved glucose homeostasis

Although diagnosed type 2 diabetes has increased in the past decade, little is known about accompanying changes in fasting plasma glucose (FPG), HbA(1c) and fasting serum insulin (FI) levels in the non-diabetic population. Using population estimates from National Health and Nutrition Examination Surveys, we compared distribution of FPG, HbA(1c) and FI in non-diabetic US persons who were >or=20 years old in 1999 to 2006 with that in persons of the same age in 1988 to 1994. Age-, sex- and race-adjusted mean FPG levels between the two study periods did not change, but mean HbA(1c) and FI levels increased (0.10% and 4.8 pmol/l, respectively; p < 0.001 for both). The increased HbA(1c) level was driven largely by an upward shift in the lower end of the HbA(1c) distribution. In contrast, the increased FI level was driven primarily by an upward shift in the middle and higher end of FI distribution, especially among persons aged 20 to 44 years. After adjustments for BMI or waist circumference, the increase in the mean HbA(1c) level was attenuated (0.06%; p < 0.001), whereas the mean FPG level decreased by 0.1 mmol/l (p < 0.001) and the mean FI level no longer demonstrated significant change. Despite little change in the distribution of FPG levels, HbA(1c) and FI levels increased in the non-diabetic population in the past decade. The increase in FI levels suggests that levels of insulin resistance were greater among US adults, especially young adults, than in the previous decade.

Clinical and Hormonal Profile of Polycystic Ovary Syndrome

ABSTRACTObjectivesThe objectives of the study were to find out the clinical features, biochemical and hormonal profile of patients with polycystic ovary syndrome (PCOS) in Bangladesh.Material and MethodsA case control and cross-sectional study was undertaken among 78 PCOS patients attending infertility clinic and 33 controls at BIRDEM Hospital, Dhaka. Inclusion criteria for cases were oligo/amenorrhea, transvaginal sonography suggesting PCO and/ or features of hyperandrogenemia with exclusion of other causes. Controls were women with regular menstrual cycle.ResultsAge and height of cases and controls were similar. BMI &gt;25 was 67% among cases and 19% among controls (P&lt;0.001); waist hip ratio &gt;0.8 was 64% among cases and 29% among controls (P&lt;0.001). Mean BMI of cases was 28.2 + 4.5 and that of cases was 21.05 + 4.1; mean fasting glucose among cases was 5.93 + 1.08 and among controls was 4.4 + 1.11 mmol/L (P&lt;0.01); mean fasting serum insulin level was 32.15+ 12.13 among cases was 11.32 +10.02 ìU/ml among controls(P&lt;.001); insulin resistance (fasting HOMA-IR&gt;6.8) was 42.32% in cases and 12% in control (P&lt;.001). Patients with PCOS had following clinical and biochemical parameters: oligomenorrhea- 74%, amenorrhea- 26%, mean Ferriman-Galaway score -19.89 + 5.06. At day 3 of menstrual cycle meanserum LH was 12.79+7.1 mmol/L, serum FSH was 5.23 + 2.5 miu/ml and serum prolactin was 415.15+180.5 mmol/L; 30% had biochemical hyperandrogenemia.ConclusionsPCOS patient in Bangladesh are usually overweight, hirsute (grade I and II), hyperandrogenemic, insulin resitant and have altered LH to FSH ratio.

Dietary Nutrients and Insulin Resistance in Urban Asian Indian Adolescents and Young Adults

Background: Asian Indians have a high prevalence of insulin resistance that may underlie their higher tendency to develop type 2 diabetes mellitus and early-onset atherosclerosis. Objective: To investigate the relationship between dietary nutrients and insulin resistance in Asian Indian adolescents and young adults. Design: Dietary nutrient intake values (24-hour dietary recall and monthly consumption data) and fasting serum insulin levels were studied in 352 (311 males and 41 females) healthy adolescents and young adults (mean age 18.0 ± 2.3 years; range 14–25 years). Bivariate and multivariate logistic regression analyses were performed with hyperinsulinemia as the outcome variable and various dietary nutrients and anthropometric variables as covariates. Results: Mean fasting serum insulin levels were 107.4 ± 35.0 pmol/l (36.5–230.4 pmol/l). The intake of polyunsaturated fatty acids (PUFAs) was higher, saturated fat and the ω–6 to ω–3 PUFA ratio were in the upper limit, and ω–3 PUFAs (% caloric intake, En) were lower than the recommended dietary allowance for Asian Indians. The PUFAs (% En), BMI, percent body fat and waist circumference were significantly higher in the hyperinsulinemic group compared with the normoinsulinemic group (p = 0.021, 0.0021, 0.0006, and 0.0041, respectively). Multiple regression analysis showed that the lowest tertile of ω–6 (<3% En) PUFA intake [adjusted OR (95% CI) = 0.3 (0.1–0.7)] and BMI [adjusted OR (95% CI) = 2.9 (1.4–6.0)] were the significant independent predictors of fasting hyperinsulinemia. Conclusion: For prevention and amelioration of insulin resistance in Asian Indian adolescents and young adults, it is prudent to have normal BMI and low intake of ω–6 PUFAs.

Pathogenesis of Virus-Induced Diabetes in Mice

Male CD-1 mice were challenged with a diabetogenic strain (E2) of coxsackievirus B4 (CVB4). At 7 weeks, 6 months, and 1 year after inoculation, mean histopathologic scores, postprandial blood glucose levels, and serum levels of antibody to islet cells were significantly elevated and mean fasting serum insulin levels significantly reduced in infected mice versus uninfected controls (P < .001 for each). At 7 weeks after infection, viral RNA, but not protein or infectious virus, was demonstrated in the pancreases of most infected mice. The pancreases of 4 of 12 and 0 of 10 infected animals were positive for viral RNA at 6 months and at 1 year after infection, respectively. Interferon-gamma-stimulated peritoneal macrophages were cytotoxic to islet cells with and without sera with high titers of islet cell autoantibody (ICA). Thus, islet cell destruction in mice infected with CVB4 strain E2 is associated with chronic islet cell inflammation, elevation of islet cell antibody, and prolonged presence of viral RNA in the pancreas. Stimulated peritoneal macrophages lyse islet cells directly and by an antibody-dependent mechanism.

Insulin Sensitivity, Glucose Effectiveness, and Body Fat Distribution Pattern in Nondiabetic Offspring of Patients With NIDDM

To determine the relationship of insulin sensitivity (SI), glucose effectiveness (glucose-dependent glucose transport [SG]), and body fat distribution patterns in glucose-tolerant offspring of patients with non-insulin-dependent diabetes mellitus (NIDDM). Ten glucose-tolerant offspring of patients with NIDDM and 10 age-, sex-, and weight-matched healthy control subjects without family history of diabetes were studied with the minimal model method of Bergman et al. Body fat composition and distribution pattern were assessed by the bioelectrical impedance analyzer and waist-hip circumference ratios (WHR), respectively, in each subject. Mean fasting serum glucose (4.39 +/- 0.17 vs. 3.94 +/- 0.17 mM) and postglucose peak (18.50 +/- 1.50 vs. 13.20 +/- 1.06 mM) levels were significantly greater (P less than 0.05) in the offspring than in the control subjects. Mean fasting serum insulin levels were slightly greater but not significantly different in the offspring versus control subjects (64 +/- 14 vs. 29 +/- 7 pM). After intravenous stimulation with glucose and tolbutamide, the mean serum insulin rose to significantly greater (P less than 0.05) levels at t = 5 and 25 min in the offspring compared with the control subjects. Mean SI was significantly reduced by 45% in the offspring compared with the control subjects (4.77 +/- 0.67 vs. 8.37 +/- 1.24 x 10(-4) min-1.mU-1.L-1). However, SG was not different in the offspring versus control subjects (1.92 +/- 0.12 vs. 2.10 +/- 0.17 x 10(-2) min-1). SI correlated significantly and inversely with the percentage of body fat mass (r = -0.580, P less than 0.05) but not with the WHR (r = -0.019) in the offspring. We found a negative association between SI and basal serum insulin (r = -0.798, P less than 0.01) but not with the poststimulation incremental insulin responses in the offspring. Family history of diabetes independently accounted for at least 27% of variance in the SI in our subjects. Our study confirmed that insulin insensitivity but not a reduced glucose effectiveness exists in young glucose-tolerant offspring of patients with NIDDM. The reduced S1 appears to be causally related to the total body fat content and may be a familial and/or genetic trait in the offspring.

Carbohydrate Tolerance and Serum Lipids in Acromegaly Before and During Treatment with High Dose Octreotide

Carbohydrate tolerance and serum lipids were studied in 14 patients with acromegaly before and in response to treatment with high dose somatostatin analogue (octreotide) over a 14-week period. Patients were assessed with respect to growth hormone (GH) profile, IGF1, HbA1, fasting lipids, and the GH, glucose, and insulin response to a standard 75 g oral glucose tolerance test (OGTT) before and during therapy. Prior to treatment mean fasting serum insulin levels were 11.7 +/- 2.8 (+/- SE) mU I-1 with a mean insulin response to OGTT of 49.8 +/- 10.8 mU I-1. Twelve of the 14 patients responded to octreotide with a reduction in mean 24-h serum GH (32.9 +/- 9.3 to 4.3 +/- 0.9 mU I-1), suppression of GH at 60 min during OGTT (3.0 +/- 0.8 mU I-1) and normalization of serum IGF1 (71 +/- 7 to 27 +/- 3 (normal 9-48 nmol I-1)). In this group the fasting insulin levels fell to 2.2 +/- 0.7 mU I-1 (p less than 0.01), and mean insulin response during OGTT was reduced (46.6 +/- 15.0 to 12.3 +/- 2.3 mU I-1) (p less than 0.01). Despite the reduction in insulin secretion there was no significant deterioration in fasting blood glucose (4.8 +/- 0.2 vs 4.6 +/- 0.4 mmol I-1), HbA1 (7.2 +/- 0.3 vs 6.8 +/- 0.3%) or mean blood glucose response to OGTT (7.9 +/- 0.7 vs 8.2 +/- 0.5 mmol I-1). Fasting triglycerides were reduced with treatment from 1.5 +/- 0.2 to 1.1 +/- 0.1 mmol I-1 (p = 0.04) in the responsive group, but serum cholesterol levels were not significantly altered (5.3 +/- 0.3 vs 5.2 +/- 0.3 mmol I-1).

Long-term follow-up of canine segmental pancreatic autografts.

The functional and morphologic characteristics of free-draining, pancreatic segmental autografts (FDPS) were studied in 8 beagle dogs that had survived longer than 4 yr. After pancreatectomy, animals received FDPS autografts of the left pancreatic limb, representing approximately one-third of the total pancreas with iliac vessel anastamoses. The grafted recipients were given pancreatic enzyme supplements (Viokase). After transplantation (tx), all 8 animals sustained fasting euglycemia with no evidence of microvascular complications. After 4 yr, IVGTT revealed K-values (%/min) that were not significantly different from age-matched controls (2.9 +/- 0.5 versus 3.7 +/- 0.6, P greater than 0.05). Mean fasting serum insulin levels were significantly greater in the tx animals (49 +/- 5 microU/ml versus 12.2 microU/ml, P less than 0.001), although the incremental response to i.v. glucose (0.5 g/kg) was less than in controls (P less than 0.05). Mean fasting plasma C-peptide levels (0.09 +/- 0.01 pmol/ml versus 0.21 +/- 0.5 pmol/ml) and peak C-peptide responses to i.v. glucose were both significantly less than in controls. Sequential pancreatic biopsies up to 2.5 yr post-tx showed atrophy of the exocrine pancreas with coalescence of islets and mild fibrosis that did not progress with time. Immunoperoxidase stains confirmed the presence of insulin, glucagon, and somatostatin within nests of islet cells. Four years after transplantation of FDPS autografts in pancreatectomized dogs, excellent function is retained. The consequences of peripheral hyperinsulinemia remain to be determined.

The behaviour of insulinaemia in patients ith liver cirrhosis after intravenous administration of glucose, tolbutamide and glucagon.

The response of both blood glucose and serum immunoreactive insulin to glucagon, glucose and tolbutamide was studied in ten patients with welldocumented, advanced liver cirrhosis and in ten healthy subjects without history indicative of liver impairment or diabetes. Glucose was administered as a rapid intravenous injection in a dose of 0.33 g/kg of body weight, tolbutamide in a dose of 1.0 g and glucagon in a dose of 1.0 mg. The mean fasting serum insulin levels of cirrhotic patients did not differ significantly from the values obtained in healthy subjects. However, after administration of glucose or tolbutamide the rise of insulinaemia was significantly higher in cases of liver cirrhosis than in normal subjects. The increase of serum insulin values after intravenous administration of glucagon was similar in both groups; thus glucagon failed to induce hyperinsulinaemia as observed after glucose or tolbutamide. The possible causes of this phenomenon have been discused.