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This study was performed to clarify the influence of liraglutide on gastric emptying in Japanese patients with type 2 diabetes. In 16 patients, the [ 13 C]-acetate breath test was performed to compare gastric emptying before and after liraglutide treatment. We found two patterns of response, with gastric emptying being delayed by liraglutide in seven patients (delayers) and not delayed in nine patients (non-delayers). The mean increase of the maximum gastric emptying time was 31 ± 4m in (p< 0.01 vs. baseline) in the delayers, while it was only 2 ± 3m in (p= 0.60 vs. baseline) in the non-delayers. The delayers showed a greater early decrease of AUC-PG from 0 to 60 min, despite no increase of the plasma insulin level compared with non-delayers. In conclusion, the effect of liraglutide treatment on gastric emptying shows heterogeneity, and patients can be classified as delayers or non-delayers.

The clinical aspects and the plasma insulin response patterns in young subjects with mild diabetes are described. Young subjects with mild diabetes have no or very few symptoms and can be controlled by diet or oral antidiabetic drugs. The mild diabetics are divided into two groups according to the fasting blood glucose concentration. Subjects having a normal fasting blood glucose concentration but a diabetic glucose tolerance test are called juvenile glucose tolerance test diabetics and those with elevated fasting blood glucose concentration and a diabetic glucose tolerance test are designated mild juvenile diabetics. It is demonstrated that juvenile glucose tolerance test diabetics have a normal plasma insulin response after i.v. glucose and tolbutamide. The plasma insulin response to oral glucose, however, is weak and slow in comparison to non-diabetics. In contradistinction, mild juvenile diabetics exhibit a weak and delayed plasma insulin response both to i.v. and oral glucose and to i.v. tolbutamide. In comparison with classic juvenile diabetics, juvenile glucose tolerance test diabetics and mild juvenile diabetics have a much higher plasma insulin level during the tests.

The plasma insulin responses of newly diagnosed, untreated, non-obese, middle-aged and old diabetics constitute a wide spectrum of responses varying with the metabolic state. The insulin response pattern after oral glucose in the mildest degree of glucose intolerance is characterized by a sustained rise in the plasma insulin concentration and a delayed decline towards the fasting level with a plasma insulin level higher than normal during the later part of the oral tests. The initial plasma insulin release in the mildest degree of glucose intolerance is, however, quite normal. In patients with more pronounced glucose intolerance the initial insulin response is proportionally more sluggish, and in severe glucose intolerance an overall diminishing of the insulin response obtains. After i.v. glucose and tolbutamide largely the same pattern is seen. The initial plasma insulin release in the mildest degree of glucose intolerance is normal. In patients with more pronounced glucose intolerance the initial insulin response is delayed, while only small changes occur during the later part of the insulin response. In the diabetics a significant positive correlation is found between the fasting plasma insulin and the fasting blood glucose concentration. A significant negative correlation is found in the diabetics between the fasting blood glucose and the increment from fasting to 15-min and 2-hour plasma insulin concentration in the oral tests and the increment from fasting to the 10-min insulin value in the i.v. tests. There is, however, no correlation between the fasting plasma insulin and the 2-hour plasma insulin concentrations in the oral tests in the diabetics. In the i.v. glucose tolerance test a significant inverse correlation exists in the diabetics between the fasting plasma insulin concentration and the increment from fasting to the 10-min plasma insulin value, while such a correlation between the same parameters does not exist in the i.v. tolbutamide test.

The effect of insulin on the ascorbate recycling system in the chicken liver was examined. First, insulin was injected subcutaneously into the chicken, and liver glutathione-dependent dehydroascorbate reductase (GSH-DHAR) activity was determined. Insulin increased liver GSH-DHAR activity, but did not affect plasma and liver ascorbate concentration. Dehydroascorbate increased plasma and liver ascorbate levels, and liver GSH-DHAR activity. However, distinct changes in plasma insulin level were not observed by dehydroascorbate injection. In addition, reduction of external dehydroascorbate in cultured chicken hepatocytes could not be observed in an insulin-deprived culture, although the cells reduced external dehydroascorbate in a serum-free culture with insulin. We concluded that insulin affects the ascorbate recycling system as an essential factor in the chicken liver.

Plasma levels of the hormones insulin and insulin-like growth factor-I (IGF-I) were assessed as indices of growth for individual juvenile coho salmon Oncorhynchus kisutch. Smolts were tagged in April, introduced to seawater in May, and reared at two different feeding levels. Fish lengths and weights were obtained in June, August, September, and November. Plasma samples were obtained in September and November. There was a consistent, robust relation (over both feeding rates and sampling dates) between plasma IGF-I and the instantaneous growth in length of individual fish when growth was measured over a 6-week period. There was no consistent association between plasma insulin level and growth, size, or condition factor. Plasma IGF-I levels were also measured in postsmolt coho salmon captured in September from the Strait of Georgia and Puget Sound and were found to be similar to those in laboratory fish.

Severe surgical or other traumatic stress initiates an integrated central nervous system and metabolic response characterized by catabolism which selectively preserves vital organs, drawing on peripheral tissue proteins for required amino acids. When oral intake is prohibited adequate intravenous nutritional support hastens convalescence and may be life-saving. Intravenous nutrients routinely consist of amino acids for replacement of lost protein, a nonprotein calorie source--usually glucose, and vitamins and minerals. Lipid, infrequently used in routine surgery as part of the calorie source, supplies essential fatty acids and prevents side effects resulting with large amounts of intravenous glucose. Lipid has other benefits. Stress-induced hormones stimulate lipid catabolism. When lipid is used for part of the calorie requirement in intravenous feedings, the plasma insulin level is reduced and peripheral amino acids become available for synthesis of critically needed visceral proteins. Recent work has shown that the branched chain amino acids carnitine and some species of lipid added to intravenous nutrient formulations postoperatively affect the nitrogen retention and may hasten convalescence. Further work should be directed at understanding the unique biochemical changes occurring after injury, devising objective assay procedures to measure the severity of the response and improving intravenous formulations for the acutely ill surgical patient.