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Endogenous Glucose Production in Type 2 Diabetes: Basal and Postprandial. Role of Diurnal Rhythms
  1. Jerry Radziuk,
  2. Susan Pye
  1. From the Diabetes and Metabolism Research Unit (J.R., S.P.), Ottawa Hospital and the University of Ottawa, Ottawa, ON.
  2. Presented in part at the American Federation for Medical Research-sponsored symposium during Experimental Biology 2004, Washington, DC, April 17-21, 2004.
  3. Supported by the Canadian Diabetes Association and the Canadian Institutes of Health Research.
  4. Address correspondence to: J. Radziuk, Ottawa Hospital (Civic Campus), 1053 Carling Avenue, Ottawa, ON K1Y 4E9; e-mail: jradziuk{at}ottawahospital.on.ca.

Abstract

Glycemia in type 2 diabetes is characterized by a nonsteady but stable diurnal cycle. This leads to morning fasting hyperglycemia. It arises from an underlying circadian pattern in endogenous glucose production because the metabolic clearance rate of glucose is decreased but constant. Therefore, it is important to use appropriate nonsteady tracer methods to measure this rate even under basal conditions. Postprandially, in diabetes, the endogenous glucose production continues to decrease, with only minor deviations from the slope of the basal curve. This suggests a decoupling of endogenous glucose production from the regulatory factors (insulin, glucose) that prevail under normal circumstances. As the duration of diabetes increases, metabolic clearance of glucose continues to deteriorate. This may be partially compensated by a decrease in glucose production. This rate remains, however, inappropriate because its impact on glycemia does not decline.

Key Words
  • tracer methods
  • insulin resistance
  • liver
  • glucose kinetics
  • circadian rhythms

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