Effects of dipeptide administration on hypoglycaemic counterregulation in type 1 diabetes

To investigate if a dipeptide made of glutamine and alanine is able to contribute to the recovery from insulin-induced hypoglycaemia in type 1 diabetes. Research design and methods: Fifteen adult type 1 patients were randomly assigned to study group (n = 7): intravenous infusion of 20 g Dipeptiven®...

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Bibliographic Details
Published in:Diabetes & metabolism 2003-09, Vol.29 (4), p.412-417
Main Authors: M'Bemba, J, Cynober, L, De Bandt, P, Taverna, M, Chevalier, A, Bardin, C, Slama, G, Selam, JL
Format: Article
Language:English
Subjects:
Acides aminés
Adult
Age of Onset
Amino Acids - metabolism
Aminoacids
Biological and medical sciences
Blood Glucose - drug effects
Blood Glucose - metabolism
Cognition
Diabetes Mellitus, Type 1 - blood
Diabète de type 1
Dipeptides
Dipeptides - administration & dosage
Dipeptides - pharmacology
Female
General and cellular metabolism. Vitamins
Glucagon - blood
Glucagon - drug effects
Glucagon - metabolism
Glucose Clamp Technique
Homeostasis
Humans
Hypoglycaemia
Hypoglycemia - blood
Hypoglycémie
Infusions, Intravenous
Insulin - blood
Insulin - metabolism
Insulin Secretion
Male
Medical sciences
Perception
Pharmacology. Drug treatments
Reference Values
Type 1 Diabetes
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Summary:To investigate if a dipeptide made of glutamine and alanine is able to contribute to the recovery from insulin-induced hypoglycaemia in type 1 diabetes. Research design and methods: Fifteen adult type 1 patients were randomly assigned to study group (n = 7): intravenous infusion of 20 g Dipeptiven® in normal saline (i.e., 8 g alanine and 13 g glutamine), or control group (n = 8): same infusion, normal saline only. A 150 min gradual hypoglycaemic hyperinsulinemic clamp was administered after 2h of infusion. Counterregularory hormones, symptoms, and cognitive function (4 choice reaction test) were regularly measured during the study. Blood glucose and glucose infusion rates were similar in the 2 groups. Circulating levels of alanine and glutamine peaked at 90 min and remained elevated throughout the test. This was associated with significant differences in: glucagonemia 107 ± 20 vs 58 ± 8 pg/ml, and neuroglycopenic symptoms scores: 7 ± 3 vs 18 ± 13, at t 150 min, in study and control group, p < 0.05. Dysautonomic symptoms, cognitive tests as well as epinephrine, norepinephrine, cortisol and growth hormone were similar between groups. Intravenous infusion of a dipeptide made of alanine and glutamine is capable to reactivate glucagon secretion during insulin-induced hypoglycaemia and to reduce hypoglycaemic symptoms. Effets de l'administration de dipeptide sur la contre-régulation de l'hypoglycémie chez le diabétique de type 1 Evaluer si un dipeptide composé de glutamine et alanine peut contribuer à lutter contre l'hypoglycémie insulinique chez le diabétique de type 1. Quinze diabétiques de type 1, adultes, ont été repartis de façon randomisée dans le groupe d'étude (n = 7) avec perfusion intraveineuse de 20g de Dipeptiven® dilué dans du sérum salé isotonique (soit 8 g d'alanine et 13 g de glutamine), ou dans le groupe contrôle: perfusion de sérum salé isotonique. Après 2 heures de perfusion, un clamp hypoglycémique graduel de 150 minutes est pratiqué. Les hormones de contre-régulation, les symptômes hypoglycémiques et les fonctions cognitives évaluées par le test de réaction à la stimulation lumineuse, sont mesurées de façon répétée pendant l'étude. Les glycémies et les débits de glucose sont similaires dans les 2 groupes. Les taux plasmatiques d'alanine et glutamine montrent un pic à 90 min et restent ensuite élevés pendant le test. A l'inverse, des différences significatives sont notées pour la glucagonémie: 107 ± 20 vs 58 ± 8 pg/ml, et pour les symptômes n
ISSN:1262-3636
1878-1780
DOI:10.1016/S1262-3636(07)70052-6