Prandial vs. first-phase insulin release

Esme12, ASN, BSN, RN · Apr 20, 2014

I am happy to help what do YOU think it is......

smf0903 · Apr 20, 2014

Well here's what I know: prandial is in response to meals and as far as I can tell, first phase is also in response to meals (or at least a spike in blood glucose). So our text is really good at using a certain description/word/phrase to describe a certain condition or set of circumstances, then later throwing a different term in to describe the same thing...which is fine, but also in my crazy brain makes me wonder "Why change this up? You used the same word 537 times in the chapter and NOW throw a new word/description in there, just this one time...there must be something different to deliberately change the wording." (Oy, my thought processes...) So, back to the question at hand...I see "prandial response...prandial response...prandial response" through the whole chapter, except for the description of Byetta, which refers to the first-phase. So I am thinking either they are the same initial burst of insulin in response to calorie intake, OR prandial can be a part of first-phase because again, in my brain, there are other reasons aside from eating that can result in a blood glucose increase (in that case first-phase would be ANY spike in insulin release no matter what the reason for the glucose increase...long story short according to THIS logic is first-phase is always the initial insulin spike which is most of the time the prandial spike, but not necessarily prandial because the increased glucose and subsequent increase in insulin may not be due to caloric intake.

If you can't tell, I get hung up on stuff! LOL

Thanks

Esme12, ASN, BSN, RN · Apr 20, 2014

You aren't way off base.....Technically they are the same process.....prandial insulin production has 2 phases. I can do on and on about this but I want you to read it for yourself.

Register for medscape. It is COMPLETELY FREE! and is an excellent resource!

In nondiabetic individuals, approximately 50% of the total daily insulin is secreted during basal periods, suppressing lipolysis, proteolysis, and glycogenolysis. The remainder of insulin secretion is postprandial. In response to a meal, there is a rapid and sizable release of preformed insulin from storage granules within the beta cell. This "first phase" of insulin secretion promotes peripheral utilization of the prandial nutrient load, suppresses hepatic glucose production, and limits postprandial glucose elevation. First-phase insulin secretion begins within 2 minutes of nutrient ingestion and continues for 10 to 15 minutes. The second phase of prandial insulin secretion follows, and is sustained until normoglycemia is restored.
First-phase insulin secretion is often represented in clinical studies by the acute insulin response to an intravenous glucose bolus. While an intravenous glucose bolus is not equivalent to an oral mixed meal, it serves as a standardized beta-cell stimulus by which first-phase insulin secretion can be carefully compared among different subjects. Further, it demonstrates the sensitivity to and insulin response of the beta cell specifically to the glucose stimulus. It is this loss of beta-cell glucose sensitivity and responsiveness that declines early in the development of type 2 diabetes, even while responses to amino acid and other stimuli are preserved.

read the entire article and let me know what questions you have.

smf0903 · Apr 20, 2014

Oh gosh, you know I read that medscape article yesterday (prior to posting here) and somehow completely missed the part that says "The second phase of prandial insulin secretion follows, and is sustained until normoglycemia is restored"...I probably would have figured it out from that sentence! Thank you so much :) That was driving me crazy!!

Esme12, ASN, BSN, RN · Apr 20, 2014

Students have SO MUCH on their plates...you are welcome!