The effect of metabolic control on leucine metabolism in type 1 (insulin-dependent) diabetic patients.

Leucine production rate, metabolic clearance rate and oxidation rate were measured in 10 Type 1 (insulin-dependent) diabetic patients after 24 h insulin withdrawal, conventional insulin therapy and an overnight insulin infusion to maintain normoglycaemia, and in 10 control subjects. In the insulin-withdrawn patients, leucine concentration (259 +/- 17 mumol/l), production rate (2.65 +/- 0.29 mumol . min-1 . kg-1) and oxidation rate (0.69 +/- 0.10 mumol . min-1 . kg-1) were significantly greater (p less than 0.001; p less than 0.05; p less than 0.005 respectively) than corresponding values in control subjects (127 +/- 6; 1.81 +/- 0.12; 0.19 +/- 0.02). Following conventional insulin therapy, leucine concentration (162 +/- 12 mumol/l) and oxidation rate (0.43 +/- 0.05 mumol . min-1 . kg-1) were lower than after insulin withdrawal but were still significantly greater than in control subjects (p less than 0.05; p less than 0.005). Although leucine concentration, production rate and metabolic clearance rate were normal after an overnight insulin infusion, leucine oxidation rate was still greater than normal (0.34 +/- 0.06 mumol . min-1 . kg-1; p less than 0.05). These results suggest that increased leucine concentration in insulin deficiency is due to elevated leucine production rate caused by increased proteolysis, and that leucine concentration is restored to normal by insulin treatment.