Abstract 523 Poster Session II, Sunday, 5/2 (poster 198)

To test the hypothesis that insulin treatment in an insulin-deficient state acutely increases plasma leptin, leptin levels were measured during the initial 24 hours of treatment of diabetic ketoacidosis (DKA). The study included 17 patients (7 M, 10 F) aged 10±1 yrs (mean±SE) with a body mass index (BMI) of 17.6±1.9 kg/m2. All patients had type 1 diabetes and were admitted in DKA. They were treated according to a standard protocol with continuous insulin infusion and fluid and electrolyte replacement. Plasma leptin was measured every 6 hours in the first 24 hours during which patients received a total insulin dose of 0.6-2.0 U/kg. Plasma leptin was 4.9±1.2 ng/mL at admission, and increased to 6.4±1.5, 7.5±1.9, 9.1±2.7, and 8.9±2.5 at 6, 12, 18 and 24 h respectively (see figure, p=0.001 by repeated measures ANOVA). Thus, leptin levels increased by 38±10% and 92±38% within 6 and 24 hours of starting insulin treatment. The increase appeared more pronounced in girls than boys (109±65% vs. 69±22%), but this difference was not statistically significant. Nonetheless, plasma leptin was significantly higher in girls than boys at admission (6.0±2 vs. 3.3±1.6 ng/mL; p=0.017) and throughout the treatment period after adjusting for age and BMI. There was no difference in the changes in plasma leptin during treatment between subjects who could eat (n=7) and those who could not (n=10). Conclusions: 1) Treatment of DKA is associated with a significant increase in plasma leptin which can be attributed to the effect of insulin on leptin production; 2) Feeding does not appear to have an independent effect on plasma leptin during DKA treatment; 3) The effect of insulin on leptin is relatively rapid and is evident within the first 6 hours of its administration.

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