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| Name | Class |
|---|---|
| University of Copenhagen | OTHER |
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In the effort of better understanding the glucose control in people with type 1 diabetes, in-depth insight into the physiology of hepatic glucose production and its influencing factors is essential. Previously, a number of potential influencing factors of hepatic glucose production have been investigated, including insulin-on-board, low carbohydrate diet, preceding ethanol intake, exercise and multiple stimulations of hepatic glucose production. Previous post-hoc analysis of dual-hormone closed-loop systems has indicated that the rate of fall in blood glucose influences the following stimulation of hepatic glucose response. However, the rate of fall in blood glucose is highly related to insulin levels, which may explain those findings. Thus, in this study the investigators want to examine whether the different rates of fall in blood glucose with similar insulin levels on board affect the hepatic glucose response in individuals with type 1 diabetes. In the study, which will be conducted at Steno Diabetes Center Copenhagen, participants will complete two study visits. On each visit, a hypoglycemic clamp technique will be used to lower the blood glucose levels of the participants (using either a rapid or slow decline rate), whereupon hepatic glucose production will be stimulated using low-dose glucagon. The study days are divided into four phases: 1) preparation phase, 2) hyperinsulinemic euglycemic phase (stabilization of blood glucose), 3) hyperinsulinemic hypoglycemic phase (rapid or slow decline in blood glucose) and 4) post-glucagon administration phase. This design will allow the investigators to examine whether differences in hepatic glucose response exist depending on preceding rate of fall in blood glucose. We hypothesize that the rate of fall in blood glucose does not affect the hepatic glucose production.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Rapid-Slow | Experimental | This arm will begin with intervention "rapid" (rapid rate of fall in plasma glucose) for the first study visit and proceed to intervention "slow" (slow rate of fall in plasma glucose) for the second study visit. |
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| Slow-Rapid | Experimental | This arm will begin with intervention "slow" (slow rate of fall in plasma glucose) for the first study visit and proceed to intervention "rapid" (rapid rate of fall in plasma glucose) for the second study visit. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Rapid lowering of plasma glucose | Other | Rapid lowering of plasma glucose using hypoglycemic clamp technique |
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| Measure | Description | Time Frame |
|---|---|---|
| Positive incremental area under the glucose curve (PI-AUC) (using the plasma glucose concentration before glucagon administration as basal level) | from 0-120 minutes after glucagon administration |
| Measure | Description | Time Frame |
|---|---|---|
| Total area under the glucose curve (AUC) | from 0-120 minutes after glucagon administration | |
| Peak plasma glucose | from 0-120 minutes after glucagon administration | |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Steno Diabetes Center Copenhagen | Gentofte Municipality | 2820 | Denmark |
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| Slow lowering of plasma glucose | Other | Slow lowering of plasma glucose using hypoglycemic clamp technique |
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| Incremental plasma glucose peak |
| from 0-120 minutes after glucagon administration |
| Time-to-peak plasma glucose | from 0-120 minutes after glucagon administration |
| Plasma glucose level | 120 minutes after glucagon administration |
| Duration of plasma glucose above 4.0 mmol/l | from 0-120 minutes after glucagon administration |
| Duration of plasma glucose above baseline | from 0-120 minutes after glucagon administration |
| Number of subjects who, after reaching a plasma glucose value > 3.9 mmol/l following glucagon administration, maintain a plasma glucose level in the range of 3.9-10 mmol/l | throughout phase 4 (until 120 minutes after glucagon administration) |
| Number of subjects who, after reaching a PG > 3.9 mmol/l following glucagon administration, maintain a plasma glucose level in the range of 3.9-7.8 mmol/l | throughout phase 4 (until 120 minutes after glucagon administration) |
| Time from glucagon administration to reaching a plasma glucose level > 3,9 mmol/l | from 0-120 minutes after glucagon administration |
| Duration of a plasma glucose level in the range of 3.9-10 mmol/l | from 0-120 minutes after glucagon administration |
| Duration of a plasma glucose level in the range of 3.9-7.8 mmol/l | from 0-120 minutes after glucagon administration |
| Change in insulin levels (measured as area under the curve) | 0-120 minutes after glucagon administration |
| Change in insulin levels (measured as peak change) | from baseline to 120 minutes after glucagon administration |
| Change in glucagon levels (measured as area under the curve) | 0-120 minutes after glucagon administration |
| Change in glucagon levels (measured as peak change) | 0-120 minutes after glucagon administration |
| Average changes in Edinburgh Hypoglycemia Scale | measured at baseline, 5 minutes prior to the end of phase 2, 5 minutes prior to the end of phase 3 and 30 and 115 minutes after glucagon administration |
| Average change in visual analogue scale score for nausea, headache, stomach ache and palpitations | measured at baseline, 5 minutes prior to the end of phase 2, 5 minutes prior to the end of phase 3 and 30 and 115 minutes after glucagon administration |
| Number of subjects experiencing vomiting | from 0-120 minutes after glucagon administration |
| ID | Term |
|---|---|
| D003922 | Diabetes Mellitus, Type 1 |
| D044882 | Glucose Metabolism Disorders |
| D007003 | Hypoglycemia |
| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
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