A SIMULATION STUDY TO DETERMINE OPTIMAL INSULIN PRIMING DURING GLUCOSE CLAMP STUDIES

Computer simulation of hyperinsulinaemic euglycaemic clamp studies (HE CS) using a novel model of insulin kinetics shows that a priming dose of insulin should be in the form of a 10-min-long infusion at a rate s ix-fold higher than the intended insulin infusion rate in patients wit h non-insulin-dependent diabetes mellitus. Using this priming regimen, glucose uptake attains equilibrium within 90 min. Two alternative pri ming regimens: a priming bolus and a monoexponential-decay priming inf usion, also result in equilibrium of glucose uptake within 90 min, but give higher transients of plasma insulin concentration. However, with no priming, or if a conventional priming regimen is used, glucose upt ake at 90 min rises to only around 80% of its equilibrium value. We co nclude that priming of insulin is essential to attain steady state of glucose uptake within 90 min of HECS and that conventionally used prim ing regimens result in an underestimation of glucose uptake.