SUMMATION OF INSULIN: DIAGNOSTIC TEST FOR INSULIN REQUIRING DIABETES

IRB PROTOCOL: PROVIDENCE HOSPITAL, SOUTHFIELD, MICHIGAN     1997-#601

EDWARD M. LICHTEN, M.D. 180 East Brown St., Birmingham, MI 48009 tele: 248.593.9999

 

Diabetic Study 2-Hour GTT
  Type DM Glucose Insulin HgB  Sum  Test- SHBG FAI
First years IDDM Height Weight BMI 0 hour 1 hour 2 hour 0 hour 1 hour 2 hour A1c C-peptide Insulin osterone   .[TT]/30*SHBG
Terry 10 30 69 194 270 15 10.6 0.24 15 1062 65 0.54
Martin I-100 69 231 8.1 0.81 130 15 0.29
Ron I-60-75 72 211 40 174 167 7 4 4 9.0 0.13

15

 434 36 0.40
Richard I-30units 75 147 164 377 387 5 7.5 7.8 6.9 0.13 20.30 436 65 0.22
David 15 units 71 229 102 180 140 4 10.7 6.8 5.4 21.50 334 31 0.36
Sidney 35 units 68 173 178 349 430 4 9.4 10.8

8.9

 24.20 470 49 0.32
Richard I-60units 74 260 197 408 333 5 15.2 4.1 10.5 24.30 287 15 0.64
David I-110unit 72 265 140 254 303 10.4 10 28 8.1 48.80 186 25 0.25
Chick diet 71 191 152 257 308 12 16 25 7.4 3.51 53.00 794 39 0.68
Gerald I-30 71.5 182 203 262 308 13.1 21.1 25.7 5.9 3.51 59.90 550 74 0.25
Thomas   I-35 69 222   156 337 272 26 32 36 7.2 4.01 94.00 120 19 0.21
Robert I-20 69 235 172 271 172 10 12 15 7.5 37.00 235 22 0.36
Donald I-20 72 274 6.9 301 43 0.23
Robert   I-117 71 255               10.0 0.37   280 38 0.25
 
  AVER AGE 0.32
Donald normal 72 246 95 108 76 14.9 46.2 18.4 4.3 79.50 298 42 0.24
Patrick normal 71 248 86 145 126 11.8 44.1 41.1 97.00 104 7 0.50
Lou diet 76 260 115 200 157 4.8 27.3 64.4 96.50 228 25 0.30
 

OBSERVATIONS FROM THE 2HOUR GLUCOSE TOLERANCE TEST WITH INSULIN

1.    INSULIN DEPENDENT DIABETIC MEN ARE UNABLE TO RELEASE INSULIN IN RESPONSE TO A GLUCOSE CHALLENGE.  Noted in RON through ROBERT

2.    NORMAL RESPONSE TO A GLUCOSE CHALLENGE IS A BASELINE INSULIN OF 10MiU/ML WITH A FOUR FOLD INCREASE AT ONE HOUR AND A 50% DROP AT TWO HOURS.

3.    THE GOAL OF DIABETIC CONTROL IS A GLYCOGENATED HEMOGLOBIN UNDER 6. NOTE THAT DAVID WAS THE ONLY ONE IN GOOD CONTROL.

4.    ALMOST ALL OF THE INSULIN REQUIRING MEN HAD A TOTAL INSULIN RELEASE, THE SUMMATION ON 0,1 AND 2 HOUR INSULIN, OF LESS THAN 70 UNITS. SEE SUM-I.

OBSERVATIONS FROM THE FREE ANDROGEN INDEX

1.    THE TOTAL TESTOSTERONE IS LESS THAN 250 NG/DL IN ONLY ONE FOURTH OF THESE INDIVIDUALS. HOWEVER, THEY HAVE AN INCREASED SEX HORMONE BINDING GLOBULIN WHICH TIES UP THE TESTOSTERONE, PREVENTING ITS ENTRY INTO THE CELLS.

2.    THE BETTER CALCULATION IS THE FREE ANDROGEN INDEX WHICH IS A MEASUREMENT OF THE BIO-AVAILABLE TESTOSTERONE. THE CALCULATION OF THE F.A.I. IS THE RATIO OF TOTAL TESTOSTERONE DIVIDED BY SEX HORMONE BINDING GLOBULIN. CONVERT pmol/L TO ng/dl BY MULTIPLYING BY 30.  THEREFORE [TT]/(30*SHBG)

3.    NORMAL FREE ANDROGEN INDEX AT 20 IS 1.0. AT 50 IS 0.7.  THE TYPICAL DIABETIC IS .3 OR LESS WITH THE MOST SEVERE DISEASE HAVING THE LOWEST RATIO.

4.     CHICK WORKED OUT 3 HOURS PER DAY TO MAINTAIN HIS NORMAL F.A.I.

OBSERVATION ON THE THREE NORMAL PATIENTS

1.    The last three patients' data that appears after the word AVERAGE are 'normals'  They were overweight with the following variations from normal: a) elevated fasting insulin, b) elevated glucose at 1 or 2 hours, and/or (c) low Free Androgen Index.

2.    Lou developed heart disease and needed a coronary artery stent at one year. He developed full blown diabetes within three years. This was treated with Metformin, testosterone replacement and strict diet.  His Hemoglobin A1c dropped from 6.4 to 5.9 on the final regimen.

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