1989 Volume 32 Issue 1 Pages 35-42
Fasting circulating levels of the major intermediary metabolites, free fatty acids (FFA), glycerol, total ketone bodies, alanine, pyruvate and lactate were measured in 91 patients with NIDDM. The concentrations of FFA, glycerol and ketone bodies were significantly higher and the concentration of alanine was significantly lower in diabetic patients than in 36 nondiabetic controls. No significant correlation was found among fasting blood glucose (FBG) and the concentrations of intermediary metabolites except lactate. Abnormalities in ketone bodies, alanine and pyruvate were not corrected in patients with good glycemic control (FBG<120mg/dl), especially in those who were on insulin therapy. However, the levels of ketone bodies, alanine and pyruvate tended to be normal in patients with normal or above normal C-peptide levels, even when these patients were hyperglycimic. In 20 patients admitted to this hospital for glycemic control, the concentrations of ketone bodies, alanine, and pyruvate worsend after hospitalization for an average of 16 days, despite marked improvement in glycemic control.
These findings indicate that the glycemic control is not always correlated with improvement in the profound metabolic abnormalities of diabetes mellitus. The goal of diabetic therapy should be to normalize not only glucose but also substrate metabolism.
