Summary
In order to reassess the role of growth hormone in the dawn phenomenon, we studied eight C-peptide negative diabetic adolescents, who are likely to exhibit important nocturnal growth hormone surges. The insulin infusion rate necessary to maintain euglycaemia was predetermined in each patient from 22.00 hours to 01.00 hours, and then kept constant until 08.00 hours resulting in stable free insulin levels. Blood glucose rose from 4.3±0.7 mmol/l at 01.00 hours to 7.1±1.1 mmol/l at 08.00 hours (p<0.01) secondary to an increased hepatic glucose production. All the subjects presented an important growth hormone secretion, ranging from 20 to 66 ng/ml (peak values) and from 3619 to 8621 ng·min· ml−1 (areas under the curve). The insulin infusion rate selected for each patient was positively correlated with the nocturnal growth hormone secretion (area under the curve) (r=0.87, p<0.01). On the other hand, there was no relationship between the nocturnal growth hormone secretion and the magnitude of the early morning blood glucose rise (r=−0.48, p>0.2). We conclude that, in Type 1 (insulin-dependent) diabetic adolescents, the dawn phenomenon exists but is moderate despite important growth hormone surges; the nocturnal growth hormone secretion influences the nocturnal insulin requirements but not the dawn phenomenon itself, if insulinisation is adequate.
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Perriello G, De Feo P, Bolli GB (1988) The dawn phenomenon: nocturnal blood glucose homeostasis in insulin dependent diabetes mellitus. Diabetic Med 5: 13–21
Geffner ME, Frank HU, Kaplan SA, Lippe BM, Levin SR (1983) Early morning hyperglycemia in diabetic individuals treated with continuous subcutaneous insulin infusion. Diabetes Care 6: 135–139
Campbell PJ, Bolli GB, Cryer PE, Gerich JE (1985) Pathogenesis of the dawn phenomenon in patients with insulin-dependent diabetes mellitus. N Engl J Med 312: 1473–1479
Campbell PJ, Bolli GB, Cryer PE, Gerich JE (1985) Sequence of events during development of the dawn phenomenon in insulin-dependent diabetes mellitus. Metabolism 34: 1100–1104
Campbell P, Cryer PE, Gerich JE (1986) Occurrence of the dawn phenomenon without a change in insulin clearance in patients with insulin-dependent diabetes mellitus. Diabetes 35: 749–752
Clarke WL, Haymond MW, Santiago JV (1980) Overnight basal insulin requirements in fasting insulin-dependent diabetics. Diabetes 29: 78–80
Bright GM, Melton TW, Rogol AD, Clarke WL (1980) Failure of cortisol blockade to inhibit early morning increases in basal insulin requirements in fasting insulin dependent diabetics. Diabetes 29: 662–664
Skor DA, White HN, Thomas L, Shah SD, Cryer PE, Santiago JV (1983) Examination of the role of the pituitary-adrenocortical axis, counterregulatory hormones and insulin clearance in variable nocturnal insulin requirements in insulin-dependent diabetics. Diabetes 32: 403–407
Skor DA, White NH, Thomas L, Santiago JV (1984) Relative roles of insulin clearance and insulin sensitivity in the prebreakfast increase in insulin requirements in insulin-dependent diabetic patients. Diabetes 33: 60–63
Skor DA, White HN, Thomas L, Santiago JV (1985) Influence of growth hormone on overnight insulin requirements in insulin-dependent diabetics. Diabetes 34: 135–139
Bolli GB, Gerich JE (1984) The “dawn phenomenon” — a common occurrence in both non insulin-dependent and insulin-dependent diabetes mellitus. N Engl J Med 310: 746–750
De Feo P, Perriello G, Ventura MM, Calcinaro F, Basta G, Lolli C, Cruciani C, Dell'Olio A, Santeusanio F, Brunetti P, Bolli GB (1986) Studies on overnight insulin requirements and metabolic clearance rate of insulin in normal and diabetic man: relevance to the pathogenesis of the dawn phenomenon. Diabetologia 29: 475–480
Bolli GB, De Feo P, De Cosmo S, Perriello G, Ventura MM, Calcinaro F, Lolli C, Campbell P, Brunetti P, Gerich JE (1984) Demonstration of a dawn phenomenon in normal human volunteers. Diabetes 33: 1150–1153
Hayford JT, Danney MM, Hendrix JM, Thompson RG (1980) Integrated concentration of growth hormone in juvenile onset diabetes. Diabetes 29: 391–398
Horner JM, Kemp SF, Hintz RL (1981) Growth hormone and somatomedin in insulin dependent diabetes mellitus. J Clin Endocrinol Metab 53: 1148–1153
Press M, Tamborlane WV, Sherwin RS (1984) Importance of raised growth hormone levels in mediating the metabolic derangements of diabetes. N Engl J Med 310: 810–815
Amiel SA, Sherwin RS, Simonson DC, Lauritano AA, Tamborlane WV (1986) Impaired insulin action in puberty: a contributing factor to poor glycemic control in adolescents with diabetes. N Engl J Med 315: 215–219
Canivet B, Berre A, Macchi P, Grimaud D, Maestracci P, Freychet P (1983) Absorption of insulin directly added to infusion bottles. Path Biol 31: 37–40
Parker DC, Sassin JF, Mace JW, Gotlin RW, Rossman LG (1969) Human growth hormone release during sleep: electroencephalographic correlation. J Clin Invest 29: 871–874
Beaufrere B, Beylot M, Riou JP, Serusclat P, Cohen R, Souquet JC, Mornex R (1983) Role of catecholamines in the ketonemic response to somatostatin in normal man. J Clin Endocrinol Metab 57: 847–850
Bier DM, Leake RD, Haymond MW, Arnold KJ, Gruenke LD, Sperling MA, Kipnis DM (1977) Measurement of “true” production rates in infancy and childhood with 6,6-dideuteroglucose. Diabetes 26: 1016–1023
Beylot M, Khalfallah Y, Riou JP, Cohen R, Normand S, Mornex R (1986) Effects of ketone bodies on basal and insulin-stimulated glucose utilization in man. J Clin Endocrinol Metab 63: 9–15
Gerbitz KD, Kemrnler W, Edelmann A, Summer J, Mehnert H, Wieland OH (1979) Free insulin, bound insulin, C peptide and the metabolic control in juvenile onset diabetes: comparison of C peptide secretors and non secretors during 24 h conventional insulin therapy. Eur J Clin Invest 9: 475–483
Ruitton A, Frederich F (1975) Specific radioimmunoassay of pancreatic glucagon: results in newborn and child. Diabete Metab 1: 143–150
Shalch DS, Parker ML (1964) A sensitive double antibody immunoassay for human growth hormone in plasma. Nature 203: 1141–1142
De Bodo RC, Steele R, Altszuler N, Dunn A, Bishop JS (1963) On the hormonal regulation of carbohydrate metabolism: studies with C14 glucose. Recent Prog Horm Res 19: 445–488
Kerner W, Navascues I, Torres AA, Pfeiffer EF (1984) Studies on the pathogenesis of the dawn phenomenon in insulin-dependent diabetic patients. Metabolism 33: 458–464
Brennan JR, Gebhart SSP, Blackard WC (1985) Pump induced insulin aggregation: a problem with the Biostator. Diabetes 34: 353–359
Dux S, White NH, Skor DA, Santiago JV (1985) Insulin clearance contributes to the variability of nocturnal insulin requirements in insulin-dependent diabetes mellitus. Diabetes 34: 1260–1265
Gerich JE, Lorenzi M, Bier DM, Tsalikian E, Schneider V, Karam JH, Forsham PH (1976) Effects of physiologic levels of glucagon and growth hormone on human carbohydrate and lipid metabolism. J Clin Invest 57: 875–884
Bratusch-Marrain PR, Smith D, De Fronzo RA (1982) The effect of growth hormone on glucose metabolism and insulin secretion in man J Clin Endocrinol Metab 55: 973–982
Mauras N, Rogol AD, Clarke WL (1986) Failure to detect the “dawn phenomenon” in non diabetic subjects with markedly different patterns of nocturnal growth hormone secretion. J Clin Endocrinol Metab 62: 975–979
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Beaufrère, B., Beylot, M., Metz, C. et al. Dawn phenomenon in Type 1 (insulin-dependent) diabetic adolescents: influence of nocturnal growth hormone secretion. Diabetologia 31, 607–611 (1988). https://doi.org/10.1007/BF00264768
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DOI: https://doi.org/10.1007/BF00264768