Borderline diabetics and their response to tolbutamide.
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Biomedical subjects
Publications and source records attributed to R J Jarrett.
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Twenty-four subjects received three oral glucose tolerance tests, in the morning, afternoon, and evening of separate days. The mean blood sugar levels in the afternoon and evening tests were similar, and they were both significantly higher than those in the morning test. Plasma immunoreactive insulin levels, however, were highest in the morning test. The pattern of insulin levels during the afternoon and evening tests resembled that described as typical of maturity-onset diabetes.
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Diurnal variation in oral glucose tolerance was studied in 122 male volunteers aged 40 yearsand over who participated in a screening health examination. In those with screening blood sugar levels exceeding 110 mg./100 ml. the degree of diurnal variation was least in those with the highest morning glycaemia; the latter also tended to have lower afternoon fasting bloodsugar levels.In a group of 40 control subjects, afternoon glucose tolerance tests yielded significantly higher post-glucose blood sugar levels. The degree of diurnal variation was significantly and inversely related to the degree of obesity.
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In two subjects concurrent infusion of amino-acids and the hormones secretin and pancreozymin provoked much higher plasma insulin levels than did administration of amino-acids or hormones individually. It is suggested that this may be a physiological phenomenon, augmenting the release of insulin from the pancreas after a meal containing protein.
Possible diurnal variation in the blood sugar response to oral glucose was studied by comparing, in the same individuals, the results of oral glucose tolerance tests performed in the morning and the afternoon. In a group of normal individuals the blood sugar levels were significantly higher in the afternoon. In hyperglycaemic individuals the diurnal variation decreased as the blood sugar levels reached during the morning test increased, so that in a group of grossly hyperglycaemic men the mean morning and afternoon tests were almost identical. The causes of this diurnal variation are not known.