Insulin infusion normalizes fasting and post-prandial albumin and fibrinogen synthesis in Type 1 diabetes mellitus

Aims The effect of metabolic control on hepatic synthesis of plasma protein s in Type 1 diabetes mellitus (T1DM), in the post-absorptive and post-prand ial state, is not known. Methods We measured fractional synthetic rates (FSR) of albumin and fibrino gen in six insulin-infused T1DM patients and in five to nine control subjec ts, before and for approx. 4 h after a mixed liquid meal. Phenylalanine tra cer precursor/product relationships and steady-state conditions were used. In the post-absorptive state, patients were studied in near euglycaemic con ditions after an overnight intravenous insulin infusion. During the meal (a pprox. 11 kcal/kg), the insulin infusion rate was increased to maintain pla sma glucose concentrations below approx. 10 mmol/l. Results Post-absorptive FSR of albumin (5.7 +/- 0.6%/day) and fibrinogen (1 1.3 +/- 0.6%/day) in T1DM were similar to control values (6.4 +/- 0.9 and 1 3.1 +/- 1.1, respectively). After the meal, albumin FSR increased (P = 0.00 32 by ANOVA) in both groups (T1DM, to 14.4 +/- 2.7%/day; controls, to 18.2 +/- 3.7%/day). Fibrinogen FSR also increased (P = 0.0048 by ANOVA) in both the T1DM (to 18.2 +/- 2.6) and the control subjects (to 27.3 +/- 6.2). Ther e was no difference between T1DM and control subjects in the postprandial F SR of both proteins. Conclusions Albumin and fibrinogen FSR in T1DM can be maintained within nea r-normal ranges by insulin infusion under post-absorptive and postprandial conditions.