Hepatic glucose extraction in normal and diabetic man

Abstract

Fractional hepatic extraction of glucose was determined from the appearance in the systemic circulation of ingested 3-[ 3H]glucose. Using the glucose clamp technique, studies were done under steady-state conditions of (1) basal glycemia and insulinemia, (2) normoglycemia (0.8 mg/mL) and mild hyperinsulinemia (∼40 μU/mL), (3) hyperglycemia (2 mg/mL −1) and hyperinsulinemia (∼100 μU/mL). Based on previous results in the dog, an oral glucose load of 2 g was used to label the portal vein glucose; this amount was chosen so as to minimize disturbance of the portal steady state but still avoid excessive loss during absorption. Additional subjects with hyperglycemia and hyperinsulinemia received an oral load of 50 g of glucose. Fractional extraction in normal subjects under near-basal conditions of glycemia and insulinemia was 19% in normal subjects and in patients with noninsulin-dependent diabetes mellitus (NIDDM) elevation of serum insulin, with or without hyperglycemia, which led to an average extraction rate of 32% of the ingested glucose. Absolute hepatic glucose uptake, calculated from the fractional extraction, the plasma glucose concentration, and hepatic plasma flow accounted for 50% to 72% of total glucose use during the various steady states and following ingestion of 50 g of glucose. It is concluded that (1) hepatic uptake or extraction, as opposed to net uptake, proceeds actively even when plasma glucose and insulin are within the normal basal range; (2) it is increased in the presence of hyperinsulinemia, with or without hyperglycemia; and (3) it is unaltered in NIDDM.