Session: S06-Insulin Pulsatility Matters
Room 122 (Moscone Center)
Early defects in type 1 and 2 diabetes (T1DM and T2DM) include impaired insulin secretion and hepatic insulin resistance. The defect in insulin secretion is due to impaired insulin pulse mass, the defect being predicted by the extent that beta cells are deficient. Thus in T2DM the insulin concentration wave front that impacts the liver is ~50% attenuated, where as in T1DM the wavefront is absent. Recent studies indicate that the physiological 5 minutely portal vein insulin concentration wave front of ~1,000 to 4,000 pmol/l (fasting to fed) is required for normal hepatic insulin signaling. The defects in T1DM and T2DM result in impaired hepatic insulin signaling and thus contribute to hepatic insulin resistance present in T1DM and T2DM. Therapeutic strategies that restore pulsatile insulin delivery therefore potentially enhance hepatic insulin action.