Measurement Of Glucose Turnover Research Articles

Glucagon-like peptide-1 receptor blockade impairs islet secretion and glucose metabolism in humans.

BACKGROUNDProglucagon can be processed to glucagon-like peptide1 (GLP-1) within the islet, but its contribution to islet function in humans remains unknown. We sought to understand whether pancreatic GLP-1 alters islet function in humans and whether this is affected by type 2 diabetes.METHODSWe therefore studied individuals with and without type 2 diabetes on two occasions in random order. On one occasion, exendin 9-39, a competitive antagonist of the GLP-1 Receptor (GLP1R), was infused, while on the other, saline was infused. The tracer dilution technique ([3-3H] glucose) was used to measure glucose turnover during fasting and during a hyperglycemic clamp.RESULTSExendin 9-39 increased fasting glucose concentrations; fasting islet hormone concentrations were unchanged, but inappropriate for the higher fasting glucose observed. In people with type 2 diabetes, fasting glucagon concentrations were markedly elevated and persisted despite hyperglycemia. This impaired suppression of endogenous glucose production by hyperglycemia.CONCLUSIONThese data show that GLP1R blockade impairs islet function, implying that intra-islet GLP1R activation alters islet responses to glucose and does so to a greater degree in people with type 2 diabetes.TRIAL REGISTRATIONThis study was registered at ClinicalTrials.gov NCT04466618.FUNDINGThe study was primarily funded by NIH NIDDK DK126206. AV is supported by DK78646, DK116231 and DK126206. CDM was supported by MIUR (Italian Minister for Education) under the initiative "Departments of Excellence" (Law 232/2016).

1547-P: The Differential Effect of Glucagon-Like Peptide-1 Receptor Blockade on Glucose Metabolism in People With and Without Type 2 Diabetes

Glucagon-Like Peptide-1 (GLP-1) is present within the islet but the effects of GLP-1 Receptor (GLP1R) blockade on islet function in humans remains unknown. To address this, we studied 12 nondiabetic individuals (54 ± 2 years, 33 ± 1 kg/m2) and 11 people with type 2 diabetes (DM2 - 58 ± 2 years, 34 ± 2 kg/m2) on 2 occasions in random order. On each occasion, after an overnight fast, [3-3H] glucose was used to measure glucose turnover during fasting and a hyperglycemic clamp (~9 mmol/l) using the tracer dilution technique. On one occasion exendin-9,39 (300pmol/kg/min) was infused to block GLP1R, while on the other saline was infused. Exendin-9,39 increased fasting glucose concentrations in those without (4.6 ± 0.4 vs. 5.5 ± 0.1 mmol/l, saline vs. exendin-9,39 respectively, p = 0.04) and in those with DM2 (7.3 ± 0.5 vs. 8.3 ± 0.6 mmol/l, p = 0.03). Fasting islet hormone concentrations were unchanged, but inappropriate for the higher fasting glucose observed during exendin-9,39 infusion. The same pattern was seen in people with DM2 except that fasting glucagon concentrations increased (8.3 ± 0.5 vs. 10.2 ± 0.6 pmol/l, p < 0.01) and remained elevated throughout hyperglycemia (4.7 ± 0.4 vs. 7.7 ± 0.6 pmol/l, p < 0.02). Insulin secretion rate calculated by deconvolution of C-peptide concentrations was also decreased in DM2 (0.54 ± 0.08 vs. 0.51 ± 0.08 nmol/min, p = 0.02). Consequently, suppression of endogenous glucose production by hyperglycemia was impaired in people with DM2 (2.9 ± 0.4 vs. 5.7 ± 0.3 μmol/kg/min, p < 0.01). Intriguingly, 1st phase response to hyperglycemia was decreased in those without DM2 (3.5 ± 0.6 vs. 2.5 ± 0.5 nmol per 10 min, p = 0.04). These data show that in humans, GLP1R blockade impairs fasting α- and β-cell function resulting in fasting hyperglycemia. Subtle effects are also present in response to hyperglycemia. This implies that intra-islet GLP1R activation sustains islet responses to glucose and it does so to a greater degree in people with DM2. Disclosure A.A. Welch: None. R.A. Farahani: None. M. Zeini: None. A.M. Egan: None. M.C. Laurenti: None. C. Cobelli: None. C. Dalla Man: Research Support; Sanofi-Aventis Deutschland GmbH, Becton, Dickinson and Company. A. Vella: Other Relationship; Novo Nordisk. Advisory Panel; Rezolute, Inc. Consultant; Crinetics Pharmaceuticals, Inc., Hanmi Pharm. Co., Ltd., Zealand Pharma A/S. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK126206)

1181-P: Consumption of Naturally Enriched Complex Carbohydrate Meal Improves Insulin Sensitivity and Disposition Index in Type 2 Diabetes

The triple tracer method has enabled accurate and concurrent measurements of glucose turnover as well as indices of insulin action and beta cell function in people with diabetes. We have previously utilized the natural enrichment of 13C polysaccharide in commercially available grains, and compared indices obtained after a complex carbohydrate (CC) meal to those obtained after a simple carbohydrate (SC) mixed meal in healthy humans. We have now completed studies in 6 subjects with type 2 diabetes (4M, age 65±6 y; BMI 33±4 kg/m2; HbA1c 50±10 mM/mol) after ~75 gm of either sorghum (naturally enriched 13C) or glucose labeled with 13C mixed meals containing ~75 gm carbs and matched protein and fat in random order. Results in figure. Glucose, insulin and C-peptide concentrations achieved were significantly lower with CC meal as compared to SC meal (p Disclosure D. Romeres: None. A. Basu: None. Y. R. Yadav: None. C. Cobelli: None. C. Dalla man: Research Support; Self; Becton, Dickinson and Company, Sanofi-Aventis Deutschland GmbH. R. Basu: None. Funding National Institutes of Health (R01DK029953 to R.B.), (R01DK085516 to A.B.), (DK059637, DK020593)

Response to Pioglitazone in Patients With Nonalcoholic Steatohepatitis With vs Without Type 2 Diabetes

Pioglitazone is effective for long-term treatment of patients with nonalcoholic steatohepatitis (NASH) with prediabetes or type 2 diabetes. However, it is not clear how the presence of type 2 diabetes affects the drug's efficacy. We compared metabolic and histologic responses to pioglitazone in patients with NASH and prediabetes vs type 2 diabetes. We performed a prospective study of adults with biopsy-proven NASH (52 with type 2 diabetes and 49 with prediabetes), enrolled from the general population of San Antonio, Texas, from 2008 through 2014. After a run-in period of approximately 4 weeks, when all baseline measurements were made (liver magnetic resonance proton spectroscopy, euglycemic insulin clamp with glucose turnover measurements, dual-energy absorptiometry, and liver biopsy), subjects were randomly assigned to groups given pioglitazone or placebo (45 mg/d) for 18 months; all procedures performed at baseline were then repeated. The primary outcome was a reduction in nonalcoholic fatty liver disease activity score of 2 points or more (for at least 2 components) without worsening of fibrosis (and expressed as difference vs placebo). Secondary outcomes included NASH resolution, individual histologic components, intrahepatic triglyceride content (measured by 1H magnetic resonance spectroscopy), and insulin sensitivity (measured by euglycemic insulin clamp). The primary outcome was met by 48% of patients with type 2 diabetes vs 46% without diabetes. Resolution of NASH was achieved in 44% of patients with type 2 diabetes vs 26% without diabetes. A significant reduction in fibrosis, from baseline, was observed only in patients with type 2 diabetes (P= .035). Intrahepatic triglyceride content was reduced by 11% ± 2% in patients with diabetes vs a reduction of 9% ± 2% in patients without diabetes (P= .62); the plasma level of alanine aminotransferase was reduced by 50 ± 10 U/L in patients with diabetes vs a reduction of 36 ± 5 U/L in patients without diabetes (P= .22). Pioglitazone was associated with a significantly greater insulin sensitivity in adipose tissue of patients with diabetes vs without diabetes (P < .001), but nonsignificant differences in responses in hepatic (P= .49) and skeletal muscle (P= .32) insulin sensitivity. In a prospective study, we found pioglitazone to be effective in patients with and without type 2 diabetes. However, pioglitazone reduced liver fibrosis and increased adipose tissue insulin sensitivity at significantly greater levels in patients with type 2 diabetes than in patients with prediabetes. Further studies are needed to determine the mechanisms by which pioglitazone reduces liver disease in patients with type 2 diabetes. ClinicalTrials.gov: NCT00994682.

Adult male northernelephant seals maintain high rates of glucose production during extended breeding fasts.

Many species undergo natural fasts as part of their life histories. Extended fasting is associated with increased β-oxidation of fatty acids and reduced oxidation of glucose to minimize commitment of body protein to gluconeogenesis. However, the metabolic strategies used to sustain extended fasts simultaneous with high rates of energy expenditure are not well understood. Studies in fasting adult female and weanling northern elephant seals (NES) have revealed high rates of endogenous glucose production (EGP) under constraints of high nutrient demand for lactation or development but relatively low rates of metabolism. These studies revealed low rates of glucose oxidation and high rates of glucose recycling through the Cori cycle. We measured rates of glucose flux in fasting adult male NES to assess how significantly longer fasting durations, higher metabolic rates, and greater rates of muscular activity affect glucose kinetics. We measured glucose turnover in 18 adult males using the clearance of [6-H3] glucose during breeding and molting. Adult male NES maintain high rates of EGP across extended fasts. EGP greatly exceeded estimated needs for glucose-dependent tissues, varied directly with plasma insulin and lactate concentrations, and was inversely related to plasma ketoacid concentrations. Together, these findings suggest that high rates of glucose production and recycling during breeding maintain high blood glucose levels to support glucose-dependent tissues while minimizing production of ketoacids and commitment of protein stores to glucose production.

Metabolic Impact of Nonalcoholic Steatohepatitis in Obese Patients With Type 2 Diabetes.

OBJECTIVENonalcoholic steatohepatitis (NASH) is increasingly common in obese patients. However, its metabolic consequences in patients with type 2 diabetes mellitus (T2DM) are unknown.RESEARCH DESIGN AND METHODSWe studied 154 obese patients divided in four groups: 1) control (no T2DM or NAFLD), 2) T2DM without NAFLD, 3) T2DM with isolated steatosis, and 4) T2DM with NASH. We evaluated intrahepatic triglycerides by proton MRS (1H-MRS) and assessed insulin secretion/resistance during an oral glucose tolerance test and a euglycemic-hyperinsulinemic clamp with glucose turnover measurements.RESULTSNo significant differences among groups were observed in sex, BMI, or total body fat. Metabolic parameters worsened progressively with the presence of T2DM and the development of hepatic steatosis, with worse hyperinsulinemia, insulin resistance, and dyslipidemia (hypertriglyceridemia and low HDL cholesterol) in those with NASH (P < 0.001). Compared with isolated steatosis, NASH was associated with more dysfunctional and insulin-resistant adipose tissue (either as insulin suppression of plasma FFA [33 ± 3 vs. 48 ± 6%] or adipose tissue insulin resistance index [9.8 ± 1.0 vs. 5.9 ± 0.8 mmol/L ⋅ µIU/mL]; both P < 0.03). Furthermore, insulin suppression of plasma FFA correlated well with hepatic steatosis (r = –0.62; P < 0.001) and severity of steatohepatitis (rs = −0.52; P < 0.001). Hepatic insulin sensitivity was also more significantly impaired among patients with T2DM and NASH, both fasting and with increasing insulin levels within the physiological range (10 to 140 µIU/mL), compared with other groups.CONCLUSIONSIn obese patients with T2DM, the presence of NAFLD is associated with more severe hyperinsulinemia, dyslipidemia, and adipose tissue/hepatic insulin resistance compared with patients without NAFLD. The unfavorable metabolic profile linked to NAFLD should prompt strategies to identify and treat this population early on.

Inhibition of glucose turnover by 3-bromopyruvate counteracts pancreatic cancer stem cell features and sensitizes cells to gemcitabine.

According to the cancer stem cell (CSC) hypothesis, the aggressive growth and early metastasis of pancreatic ductal adenocarcinoma (PDA) is due to the activity of CSCs, which are not targeted by current therapies. Otto Warburg suggested that the growth of cancer cells is driven by a high glucose metabolism. Here, we investigated whether glycolysis inhibition targets CSCs and thus may enhance therapeutic efficacy. Four established and 3 primary PDA cell lines, non-malignant cells, and 3 patient-tumor-derived CSC-enriched spheroidal cultures were analyzed by glucose turnover measurements, MTT and ATP assays, flow cytometry of ALDH1 activity and annexin positivity, colony and spheroid formation, western blotting, electrophoretic mobility shift assay, xenotransplantation, and immunohistochemistry. The effect of siRNA-mediated inhibition of LDH-A and LDH-B was also investigated. The PDA cells exhibited a high glucose metabolism, and glucose withdrawal or LDH inhibition by siRNA prevented growth and colony formation. Treatment with the anti-glycolytic agent 3-bromopyruvate almost completely blocked cell viability, self-renewal potential, NF-κB binding activity, and stem cell-related signaling and reverted gemcitabine resistance. 3-bromopyruvate was less effective in weakly malignant PDA cells and did not affect non-malignant cells, predicting minimal side effects. 3-bromopyruvate inhibited in vivo tumor engraftment and growth on chicken eggs and mice and enhanced the efficacy of gemcitabine by influencing the expression of markers of proliferation, apoptosis, self-renewal, and metastasis. Most importantly, primary CSC-enriched spheroidal cultures were eliminated by 3-bromopyruvate. These findings propose that CSCs may be specifically dependent on a high glucose turnover and suggest 3-bromopyruvate for therapeutic intervention.

Role of carotid bodies in glucose counterregulation in type 1 diabetes (709.2)

Carotid bodies (CB) are desensitized by hyperoxia/hyperglycemia and sensitized by hypoxia/hypoglycemia. We have reported in healthy humans that CB chemoreceptors secrete counterregulatory hormones in response to normoxia and hypoglycemia. While the role of central nervous system in glucose counterregulation is known, it is unknown whether alteration in CB response to glucose contributes to the pathogenesis of hypoglycema in T1D. We hypothesized that glucose counterregulation is impaired in T1D due to reduced sensitization of CB. 10 T1D and 12 healthy subjects (ND), matched for BMI (23 ± 3 vs 26 ± 5 kg/m2) underwent a 180 min hyperinsulinemic (2 mU/kg TBW/min), hypoglycemic clamp (~3.3mM) under normoxic conditions (SpO2 98 ± 1%). T1D subjects did not report autonomic symptoms. [3‐3H] glucose was infused to measure glucose turnover. Results were compared using means of last forty minutes of clamp data. Statistical analyses were done using unpaired t‐tests and p&lt;0.05 was considered significant.In the presence of matched glucose (3.3±0.1 vs.3.3±0.1 mM) and insulin concentrations (783±106 vs. 812±185 pM;p=0.66), counterregulatory hormonal responses epinephrine (274 ± 165 vs. 742 ± 279 pg/ml) and glucagon (30 ± 11 vs 105 ± 31pg/ml) to hypoglycemia were significantly lower (p&lt;0.001) in T1D vs. ND respectively. The glucose infusion rate required to maintain hypoglycemia was significantly higher (36 ± 1 vs.28 ± 0 µmol/kg/min, p &lt;0.001) and endogenous glucose production was significantly lower (10 ± 3 vs.14 ± 4 µmol/kg/min, p&lt;0.05) in T1D vs. ND with unchanged insulin stimulated glucose uptake. We conclude that in T1D the CB sensitivity to hypoglycemia is impaired and may contribute to increased risk of hypoglycemia in these individuals. Future studies are required to evaluate CB response in hypoglycemia unaware individuals with T1D.Grant Funding Source: DK90541

β-Adrenergic Responsive Induction of Insulin Resistance in Liver of Aging Rats

Introduction. We previously demonstrated increases in β-adrenergic receptor (β-AR) density in rat liver, in association with increased β-AR-mediated stimulation of glucose output in rat hepatocytes, during senescent aging. We therefore hypothesized that pharmacologic β-adrenergic stimulation might induce insulin resistance and glucose output in liver of aging rats in vivo. Methods. In this study, pancreatic clamps were performed on young adult (4-month-old) and senescent (24-month-old) Fischer 344 male rats by infusing somatostatin (3 μg/kg/min) at time 0 to inhibit insulin secretion, and then infusing insulin (1 mU/kg/min) to replace basal insulin concentrations. At time 0 rats also received either the β-AR agonist isoproterenol (100 ng/kg/min) or saline (control). After 120 min the insulin infusion rate was increased to 4 mU/kg/min for an additional 120 min. Tritiated glucose was infused throughout the study to measure glucose turnover rates. Results and Conclusion. The results of the pancreatic clamp studies demonstrated that under saline control conditions hepatic glucose production (HGP) was suppressed during hyperinsulinemia in both young and old rats, with a trend toward reduced insulin sensitivity in the older animals. Isoproterenol infusion impaired insulin-induced suppression of HGP in both age groups. The results suggest that β-AR stimulation by isoproterenol increases HGP and acutely induces hepatic insulin resistance in both young and old rats. A similar role for β-adrenergic-mediated hepatic insulin resistance in aging humans would suggest a novel therapeutic target for the treatment or prevention of glucose dysregulation and diabetes developing with advancing age.

Additional Evidence That Transaldolase Exchange, Isotope Discrimination During the Triose-Isomerase Reaction, or Both Occur in Humans

OBJECTIVETo determine whether deuterium enrichment on carbons 5 and 3 (C5/C3) in plasma glucose is influenced by processes other than gluconeogenesis and, if so, whether these processes are altered by type 2 diabetes.RESEARCH DESIGN AND METHODSIn this study, 10 obese diabetic and 10 obese nondiabetic subjects were infused intravenously with [3,5-2H2] galactose enriched at a C5-to-C3 ratio of 1.0 as well as the enrichment of deuterium on C5 and C3 of plasma glucose, measured with nuclear magnetic resonance using the acetaminophen glucuronide method.RESULTSThe ratio of deuterium enrichment on C5 and C3 of glucose was <1 (P < 0.001) in all of the diabetic and nondiabetic subjects, resulting in a means ± SE C5-to-C3 ratio that did not differ between groups (0.81 ± 0.01 vs. 0.79 ± 0.01, respectively).CONCLUSIONSThat the C5-to-C3 glucose ratio is <1 indicates that transaldolase exchange, selective retention of deuterium at the level of the triose-isomerase reaction, or both occur in humans. This also indicates that the net effect of these processes on the C5-to-C3 ratio is the same in people with and without type 2 diabetes. The possible effects of transaldolase exchange or selective retention of deuterium (or tritium) at the level of the triose-isomerase reaction on tracee labeling and tracer metabolism should be considered when the deuterated water method is used to measure gluconeogenesis or [3-3H] glucose is used to measure glucose turnover in humans.

Exenatide Sensitizes Insulin-Mediated Whole-Body Glucose Disposal and Promotes Uptake of Exogenous Glucose by the Liver

OBJECTIVE— Recent progress suggests that exenatide, a mimetic of glucagon-like peptide-1 (GLP-1), might lower glycemia independent of increased β-cell response or reduced gastrointestinal motility. We aimed to investigate whether exenatide stimulates glucose turnover directly in insulin-responsive tissues dependent or independent of insulinemia.RESEARCH DESIGN AND METHODS— An intraportal glucose infusion clamp was used in dogs to measure glucose turnover to encompass potent activation of the putative glucose/GLP-1 sensor in the porto-hepatic circulation with exenatide. The modified glucose clamp was performed in the presence of postprandial hyperinsulinemia and hyperglycemia with exenatide (20 μg) or saline injected at 0 min. Furthermore, the role of hyperglycemia versus hyperinsulinemia in exenatide-mediated glucose disposal was studied.RESULTS— With hyperinsulinemia and hyperglycemia, exenatide produced a significant increase in total glucose turnover by ∼30%, as indicated by portal glucose infusion rate (saline 15.9 ± 1.6 vs. exenatide 20.4 ± 2.1 mg · kg−1 · min−1, P < 0.001), resulting from increased whole-body glucose disposal (Rd, ∼20%) and increased net hepatic uptake of exogenous glucose (∼80%). Reducing systemic hyperglycemia to euglycemia, exenatide still increased total glucose turnover by ∼20% (saline 13.2 ± 1.9 vs. exenatide 15.6 ± 2.1 mg · kg−1 · min−1, P < 0.05) in the presence of hyperinsulinemia, accompanied by smaller increments in Rd (12%) and net hepatic uptake of exogenous glucose (45%). In contrast, reducing hyperinsulinemia to basal levels, exenatide-increased total glucose turnover was completely abolished despite hyperglycemia (saline 2.9 ± 0.6 vs. exenatide 2.3 ± 0.3 mg · kg−1 · min−1, P = 0.29).CONCLUSIONS— Exenatide directly stimulates glucose turnover by enhancing insulin-mediated whole-body glucose disposal and increasing hepatic uptake of exogenous glucose, contributing to its overall action to lower postprandial glucose excursions.

Subcutaneous Infusion and Capillary “Finger Stick” Sampling of Stable Isotope Tracer in Metabolic Studies

Metabolic studies utilizing stable isotope tracer in humans have typically used intravenous tracer infusions and venous blood sampling. These studies explore subcutaneous infusion of isotope and "finger stick" capillary blood sampling to measure glucose turnover. Five subjects received simultaneous 8-h infusions of glucose labeled with isotope: [1-(13)C]glucose subcutaneously and [6,6-(2)H(2)]glucose intravenously. At regular intervals, venous and finger stick blood specimens were obtained. Finger stick blood was applied to filter paper. Substrate and isotopic steady state was reached after 7.0 h with both routes of infusion. The isotopic enrichments of finger stick and venous specimens did not differ significantly for the subcutaneously infused [1-(13)C]glucose (p = 0.33 and p = 0.23, respectively) but the finger stick [6,6-(2)H(2)]glucose enrichment was slightly higher (p < 0.03) than that of the venous sample. Using [6,6-(2)H(2)]glucose infusion and venous plasma sampling as the reference method, the [1-(13)C]glucose gave estimates of glucose R(a) that were 13% (plasma) and 17% (finger stick) lower (p < 0.001 and p < 0.02, respectively). This difference could be attributed to recycling of (13)C label. In conclusion, subcutaneous infusion and finger stick specimen collection onto filter paper represent a potential method of conducting in vivo studies of substrate metabolism outside of a hospital-based research unit.

Impact of portal glucose delivery on glucose metabolism in conscious, unrestrained mice

Previous studies in mice suggest that portal venous infusion of glucose at a low rate paradoxically causes hypoglycemia; this does not occur in dogs, rats, and humans. A possible explanation is that fasting status in the mouse studies may have altered the response. We sought to determine whether the response to portal glucose delivery in the mouse was similar to that seen in other species and whether it was dependent on fasting status. Studies were performed on chronically catheterized conscious mice. Catheters were placed into the portal and jugular veins and carotid artery 5 days before study. After a 5- or 16-h fast, glucose was infused into either the portal (PO) or the jugular vein (JU) for 6 h at 25 microg.g(-1).min(-1). [3-(3)H]glucose was infused into the JU to measure glucose turnover. In 5-h-fasted mice, PO and JU exhibited similar increases in arterial blood glucose from 155 +/- 11 to 173 +/- 19 and 147 +/- 8 to 173 +/- 10 mg/dl, respectively. Endogenous glucose production decreased and arterial insulin increased to the same extent in both PO and JU. A similar response was observed in 16-h-fasted mice; however, the proportion of hepatic glycogen synthesis occurring by the indirect pathway was increased by fasting. In summary, portal glucose delivery in the mouse did not cause hypoglycemia even when the duration of the fast was extended. The explanation of the differing response from previous reports in the mouse is unclear.

Glucose production, gluconeogenesis, and hepatic tricarboxylic acid cycle fluxes measured by nuclear magnetic resonance analysis of a single glucose derivative

A triple-tracer method was developed to provide absolute fluxes contributing to endogenous glucose production and hepatic tricarboxylic acid (TCA) cycle fluxes in 24-h-fasted rats by 2H and 13C nuclear magnetic resonance (NMR) analysis of a single glucose derivative. A primed, intravenous [3,4- 13C 2]glucose infusion was used to measure endogenous glucose production; intraperitoneal 2H 2O (to enrich total body water) was used to quantify sources of glucose (TCA cycle, glycerol, and glycogen), and intraperitoneal [U- 13C 3] propionate was used to quantify hepatic anaplerosis, pyruvate cycling, and TCA cycle flux. Plasma glucose was converted to monoacetone glucose (MAG), and a single 2H and 13C NMR spectrum of MAG provided the following metabolic data (all in units of μmol/kg/min; n=6): endogenous glucose production (40.4 ± 2.9), gluconeogenesis from glycerol (11.5 ± 3.5), gluconeogenesis from the TCA cycle (67.3 ± 5.6), glycogenolysis (1.0 ± 0.8), pyruvate cycling (154.4 ± 43.4), PEPCK flux (221.7 ± 47.6), and TCA cycle flux (49.1 ± 16.8). In a separate group of rats, glucose production was not different in the absence of 2H 2O and [U- 13C]propionate, demonstrating that these tracers do not alter the measurement of glucose turnover.

In normal men, free fatty acids reduce peripheral but not splanchnic glucose uptake.

Raising plasma free fatty acid (FFA) levels reduces muscle glucose uptake, but the effect of FFAs on splanchnic glucose uptake, total glucose output, and glucose cycling may also be critical to producing lipid-induced glucose intolerance. In eight normal volunteers, we measured glucose turnover and cycling rates ([2H7]glucose infusion) during a moderately hyperglycemic (7.7 mmol/l) hyperinsulinemic clamp, before and after ingestion of a labeled (dideuterated) oral glucose load (700 mg/kg). Each test was performed twice, with either a lipid or a saline infusion; four subjects also had a third test with a glycerol infusion. As shown by similar rates of exogenous glucose appearance, the lipid infusion did not reduce first-pass splanchnic glucose uptake (saline 1.48+/-0.18, lipid 1.69+/-0.17, and glycerol 1.88+/-0.17 mmol/kg per 180 min; NS), but it reduced peripheral glucose uptake by 40% (P < 0.01 vs. both saline and glycerol infusions). Before oral ingestion of glucose, total glucose output was similarly increased by the lipid and glycerol infusions. Total glucose output was significantly increased by FFAs after oral ingestion of glucose (saline 3.68+/-1.15, glycerol 3.68+/-1.70, and lipid 7.92+/-0.88 micromol x kg(-1) x min(-1); P < 0.01 vs. saline and P < 0.05 vs. glycerol). The glucose cycling rate was approximately 2.7 micromol x kg(-1) x min(-1) with the three infusions and tended to decrease all along the lipid infusion, which argues against a stimulation of glucose-6-phosphatase by FFAs. It is concluded that in situations of moderate hyperinsulinemia-hyperglycemia, FFAs reduce peripheral but not splanchnic glucose uptake. Total glucose output is increased by FFAs, by a mechanism that does not seem to involve stimulation of glucose-6-phosphatase.

Effect of glucose-dependent insulinotropic polypeptide on whole-body glucose utilization in sheep.

Four adult Corriedale sheep were used in an experiment divided into three parts. In part 1 a primed continuous infusion of [6, 6-2H2]glucose was infused for 7 h. The first 3 h was the control period, from 3 to 7 h glucose-dependent insulinotropic polypeptide (GIP) was infused, and from 5 to 7 h somatostatin was infused. Part 2 of the experiment was the same as for part 1 except that insulin was infused between 3 h and 7 h and GIP was infused between 5 and 7 h. Coincident with the insulin infusion, normal glucose was also infused at a variable rate in order to keep the plasma glucose at basal levels. In part 3 of the experiment [6,6-2H2]glucose was infused for 5 h and somatostatin was infused between 3 and 5 h. Measurements of glucose turnover were made in the last 40 min of the control, GIP only, insulin only, somatostatin only, GIP plus somatostatin and GIP plus insulin infusion periods. Plasma insulin levels were reduced to the limit of detection by the somatostatin infusion; under such conditions whole-body glucose uptake should be entirely non-insulin-mediated (NIMGU). Expressing glucose disposal as glucose metabolic clearance rate demonstrated that elevated, but still physiological GIP levels had no effect on NIMGU but significantly increased insulin-mediated glucose uptake when plasma insulin levels were similar to levels typically observed after a meal. These results indicate that in sheep, GIP may enhance insulin action with respect to glucose disposal following a meal, but has no effect on glucose disposal pathways not responsive to insulin.

Measurement of Hepatic Glucose Output, Krebs Cycle, and Gluconeogenic Fluxes by NMR Analysis of a Single Plasma Glucose Sample

13C and1H NMR spectroscopy of plasma glucose was used to resolve the isotopomer contributions from tracer levels of [1,6-13C2]glucose, a novel tracer of glucose carbon skeleton turnover, and [U-13C]propionate, a tracer of hepatic citric acid cycle metabolism. This allowed simultaneous measurements of hepatic glucose production and citric acid cycle fluxes from the NMR analysis of a single plasma glucose sample in fasted animals. Glucose carbon skeleton turnover, as reported by the dilution of [1,6-13C2]glucose, was 56 ± 2 μmol/kg/min in the presence of labeling from [U-13C]propionate and 53 ± 4 μmol/kg/min in its absence. Therefore, as expected, the labeling contributions from [U-13C]propionate metabolism did not have a significant effect on the measurement of glucose turnover. For the group infused with both tracers, citric acid cycle flux estimates from the analysis of glucose C2 isotopomer ratios were consistent with those from our recent experiments where only [U-13C]propionate was infused, verifying that the presence of [1,6-13C2]glucose did not interfere with these measurements. This integrated analysis of hepatic glucose output and citric acid cycle fluxes from plasma glucose isotopomers yielded a noninvasive estimate of hepatic citrate synthase flux of 74 ± 12 μmol/kg/min for 24-h fasted rats.

Measurement of glucose turnover--implications for the study of inborn errors of metabolism.

Aspects of glucose metabolism have been investigated quantitatively employing stable isotopes for 20 year. Use of non-recycling [6,6-2H2] or [U-13C] glucose labels provides a value for total hepatic glucose production (glycogenolysis plus gluconeogenesis). Quantitation of gluconeogenesis with isotopic tracers has itself recently been revisited employing protocols and analytical options that purport to overcome the isotope exchanges (dilution) experienced at the level of oxaloacetate when the rate of incorporation of label into glucose from infused alanine, lactate or pyruvate is monitored. Labelled glucose has been employed to investigate metabolic disturbances of glycogen storage disease type I (GSD-I) and type III (GSD-III). Endogenous glucose production and glucose recycling have been studied in both these storage diseases employing a primed-continuous infusion of D-[U-13C] glucose and quantitation of isotope enrichments and isotopomer distribution observed in plasma glucose either by mass spectrometry or nuclear magnetic resonance spectroscopy. General aspects of glucose metabolism as investigated with stable isotopes are presented.

Growth hormone does not affect non-insulin-mediated glucose uptake in sheep.

Four adult Merino sheep were used in the experiment, which was divided into four parts. For the 5 days before parts 1 and 3 saline was injected and for the 5 days before parts 2 and 4 growth hormone (GH; 4 mg day-1 subcutaneously) was injected. In parts 1 and 2 a primed continuous infusion of [6,6-2H2]glucose and either saline or GH, respectively, were infused for 5 h. The first 3 h was the control period. From 3 to 5 h insulin (0.5 mU kg-1 min-1) was infused. Coincident with the insulin infusion, normal glucose was also infused at a variable rate, dependent on the rapidly determined plasma glucose concentration, in order to keep the plasma glucose concentration constant. Parts 3 and 4 of the experiment were the same as parts 1 and 2, respectively, except for the following: the glucose isotope and saline or GH were infused for 7 h, from 3 to 7 h somatostatin (SRIF; 0.417 microgram kg-1 min-1) was infused, and from 5 to 7 h insulin was infused. Measurements of glucose turnover were made in the last 40 min of the control, insulin-only, SRIF-only and insulin-plus-SRIF infusion periods. Plasma insulin levels were reduced to below the level of detection by the SRIF infusion; under such conditions whole body glucose uptake should be entirely non-insulin mediated (NIMGU). Expressing glucose uptake as glucose metabolic clearance rate revealed that GH had no effect on NIMGU but significantly reduced the level of insulin-mediated glucose uptake (IMGU). Thus a reduction in the rate of NIMGU is probably not part of the mechanism by which GH repartitions glucose to sites of growth and milk production, whilst the present study confirms the antagonistic effect of GH on IMGU.

Paradoxically enhanced glucose production during exercise in humans with blocked glycolysis caused by muscle phosphofructokinase deficiency.

Muscle phosphofructokinase deficiency (PFKD) is characterized by exercise intolerance due to the enzymatic block in muscle glycolysis. Glucose infusion increases exertional fatigue in these patients, probably by decreasing the availability of free fatty acids (FFA) and ketones, which play a crucial role in ATP production during exercise in PFKD. This suggests that a lower than normal hepatic glucose production would be appropriate during exercise in PFKD. To investigate glucoregulation in PFKD, we measured glucose turnover and hormonal and metabolic responses to 20 minutes of cycle exercise at near maximal effort in three patients with PFKD and in healthy matched controls studied at the same absolute (A, 15 to 30 Watts) and relative (R, 35 to 80 Watts, matched heart rates) work load as the patients. During exercise, mean glucose production was higher in all patients versus controls (30 +/- 4 versus A: 18 +/- 2 and R: 20 +/- 1 mumol.min-1.kg-1). Mean glucose utilization during exercise was similar in patients and controls working at the same relative work load and higher than in controls at the low work load. Exercise-induced increases in arterialized blood were higher in all patients for glucose, FFA, growth hormone, glucagon, and norepinephrine. Plasma alanine and lactate always decreased during exercise in patients and consistently increased in controls. In conclusion, an enhanced neuroendocrine response and a paradoxically exaggerated mobilization of glucose occurs during exercise in PFKD. The responses are probably initiated by neural feedback elicited by disturbances in local muscle metabolism. The responses promote delivery of oxidizable fat to muscle, but at the expense of accumulation and futile cycling of glucose.