Net Hepatic Glucose Balance Research Articles

1341-P: Dietary Fat and Fructose Impair Glucagon-Stimulated Liver Glucose Metabolism

High fat and fructose diets (HFFD) disrupt glucose metabolism. The aim of this study was to determine the effect of HFFD on glucagon (GGN) effectiveness. Dogs were fed either chow or HFFD for one month. After a basal sampling period, somatostatin and basal portal vein infusions of insulin and GGN were given for 4h, with the exception of GGN, which was either maintained at basal or increased 6-fold. Glucose was infused in the basal GGN groups (CHOW+GLC & HFFD+GLC) to match the 3-fold increase in plasma glucose that occurred with 6x-GGN (CHOW+GGN & HFFD+GGN) . There were no differences in plasma insulin or glucose and GGN levels were proportional to GGN infusion rates in all groups. 6x-GGN caused an identical increase in net hepatic glucose balance (NHGB) in the chow and HFFD groups (Fig 1A) after which NHGB declined. During the last hour NHGB was 1.8-fold greater in HFHF+GGN compared to Chow+GGN (A) . However, hyperglycemia per se caused a switch from net hepatic glucose output to uptake in Chow+GLC but not HFHF+GLC (there was a 3.7±0.4 vs. 0.3±0.4 mg/kg/min decrease in NHGB over time in the two groups, respectively) (B) . Thus, when expressed relative to each group’s respective glucose control group, the AUC for GGN stimulated NHGB was 1.9-fold greater in the Chow (C) compared to HFHF (D) groups (P<0.05) . In summary, HFHF feeding reduced hepatic glucagon action indirectly by impairing hepatic glucose effectiveness. Disclosure D.S.Edgerton: None. G.Kraft: None. K.C.Coate: None. B.Farmer: None. M.S.Smith: None. M.Scott: None. J.R.Hastings: None. M.C.Moore: None. A.D.Cherrington: Advisory Panel; Biocon, Diakard, Metavention, Sekkei Bio, Sensulin Labs, LLC, vTv Therapeutics, Consultant; Abvance, Fractyl Health, Inc., Novo Nordisk, Research Support; Bristol-Myers Squibb Company. Funding NIH R01DK18243

367-OR: High-Fat and Fructose Feeding Severely Impairs Hepatic Glucose Effectiveness

Diets high in fat and fructose (HFFD) disrupt glucose metabolism. The aim of this study was to determine if HFFD impairs hepatic glucose effectiveness (i.e., the ability of glucose per se to stimulate net hepatic glucose uptake [NHGU] and/or to suppress glucose production [Ra]). In overnight fasted dogs fed either a chow diet or HFFD for 1 month, somatostatin, 3-3H-glucose, and basal hepatic portal vein infusions of insulin and glucagon were given. After a basal sampling period, these infusions continued for 4h while glucose was infused to create a 3-fold rise in plasma glucose. Since hepatic glucose uptake is also stimulated by a negative arterial to portal vein glucose gradient, such as occurs with glucose ingestion, glucose was either all infused into a peripheral vein (Chow-PeG, n=6; HFFD-PeG, n=6), or a portion was also given into the portal vein (4 mg/kg/min; Chow-PoG, n=5; HFFD-PoG, n=5). There were no differences in plasma insulin, glucagon, arterial glucose, or hepatic glucose load between groups. In response to hyperglycemia, the liver switched from making (basal period) to storing (last h) glucose in the chow fed groups (1.1±0.1 to -2.0±0.5* mg/kg/min in Chow-PeG, and 1.3±0.1 to -3.0±0.9* in Chow-PoG; a negative rate indicates uptake). Conversely, HFFD markedly reduced liver glucose effectiveness. In fact, with HFFD the liver did not take up glucose in response to hyperglycemia whether the portal signal was absent (1.4±0.1 to 1.0±0.3 in HFFD-PeG) or present (1.6±0.3 to 0.0±0.3* in HFFD-PoG). Thus, in the Chow vs. HFFD groups, the impact of hyperglycemia on overall net hepatic glucose balance was 3.1±0.5 vs. 0.4±0.4* (13% of normal) in the absence of portal glucose delivery and 4.3±0.9 vs. 1.6±0.5* (37% of normal) in its presence. Hyperglycemia suppressed Ra by 75±12 vs. 22±6%* (last h) in Chow vs. HFFD-PeG, respectively, and by 81±14 vs. 34±7%* in Chow vs. HFFD-PoG. In summary, HFFD induced a severe impairment in hepatic glucose effectiveness but did not affect the liver’s response to the portal glucose signal. (*P<0.05). Disclosure D.S. Edgerton: None. G. Kraft: None. B. Farmer: None. M. Scott: None. M.S. Smith: None. A.D. Cherrington: Advisory Panel; Self; Biocon, Fractyl Laboratories, Inc., Metavention, Sekkei Bio, Sensulin, LLC., vTv Therapeutics, Zafgen, Inc. Consultant; Self; Thetis Pharmaceuticals LLC. Research Support; Self; Diasome Pharmaceuticals, Inc. Other Relationship; Self; Abvance Therapeutics, Novo Nordisk Inc. Funding National Institutes of Health (R01DK18243)

Sympathetic Denervation of the Common Hepatic Artery Lessens Glucose Intolerance in the Fat- and Fructose-Fed Dog.

This study assessed the effectiveness of surgical sympathetic denervation of the common hepatic artery (CHADN) in improving glucose tolerance. CHADN eliminated norepinephrine content in the liver and partially decreased it in the pancreas and the upper gut. We assessed oral glucose tolerance at baseline and after 4 weeks of high-fat high-fructose (HFHF) feeding. Dogs were then randomized to sham surgery (SHAM) (n = 9) or CHADN surgery (n = 11) and retested 2.5 or 3.5 weeks later while still on the HFHF diet. CHADN improved glucose tolerance by ∼60% in part because of enhanced insulin secretion, as indicated by an increase in the insulinogenic index. In a subset of dogs (SHAM, n = 5; CHADN, n = 6), a hyperinsulinemic-hyperglycemic clamp was used to assess whether CHADN could improve hepatic glucose metabolism independent of a change in insulin release. CHADN reduced the diet-induced defect in net hepatic glucose balance by 37%. In another subset of dogs (SHAM, n = 4; CHADN, n = 5) the HFHF diet was continued for 3 months postsurgery and the improvement in glucose tolerance caused by CHADN continued. In conclusion, CHADN has the potential to enhance postprandial glucose clearance in states of diet-induced glucose intolerance.

Glucose autoregulation is the dominant component of the hormone-independent counterregulatory response to hypoglycemia in the conscious dog.

The contribution of hormone-independent counterregulatory signals in defense of insulin-induced hypoglycemia was determined in adrenalectomized, overnight-fasted conscious dogs receiving hepatic portal vein insulin infusions at a rate 20-fold basal. Either euglycemia was maintained (group 1) or hypoglycemia (≈45 mg/dl) was allowed to occur. There were three hypoglycemic groups: one in which hepatic autoregulation against hypoglycemia occurred in the absence of sympathetic nervous system input (group 2), one in which autoregulation occurred in the presence of norepinephrine (NE) signaling to fat and muscle (group 3), and one in which autoregulation occurred in the presence of NE signaling to fat, muscle, and liver (group 4). Average net hepatic glucose balance (NHGB) during the last hour for groups 1-4 was -0.7 ± 0.1, 0.3 ± 0.1 (P < 0.01 vs. group 1), 0.7 ± 0.1 (P = 0.01 vs. group 2), and 0.8 ± 0.1 (P = 0.7 vs. group 3) mg·kg-1·min-1, respectively. Hypoglycemia per se (group 2) increased NHGB by causing an inhibition of net hepatic glycogen synthesis. NE signaling to fat and muscle (group 3) increased NHGB further by mobilizing gluconeogenic precursors resulting in a rise in gluconeogenesis. Lowering glucose per se decreased nonhepatic glucose uptake by 8.9 mg·kg-1·min-1, and the addition of increased neural efferent signaling to muscle and fat blocked glucose uptake further by 3.2 mg·kg-1·min-1 The addition of increased neural efferent input to liver did not affect NHGB or nonhepatic glucose uptake significantly. In conclusion, even in the absence of increases in counterregulatory hormones, the body can defend itself against hypoglycemia using glucose autoregulation and increased neural efferent signaling, both of which stimulate hepatic glucose production and limit glucose utilization.

Novel PEGylated basal insulin LY2605541 has a preferential hepatic effect on glucose metabolism.

The impact of the novel basal insulin LY2605541 (LY) on hepatic and nonhepatic glucose uptake (non-HGU) was evaluated. Conscious dogs underwent euglycemic clamps with tracer and hepatic balance measurements. Clamp period infusions were peripheral venous regular insulin (0.1 nmol ⋅ kg−1 ⋅ h−1 [control], n = 6) or LY (bolus [nmol/kg], continuous [nmol ⋅ kg−1 ⋅ h−1]: 0.5, 0.5 [n = 6]; 0.375, 0.375 [n = 5]; 0.25, 0.25 [n = 4]), somatostatin, and glucose, as well as intraportal glucagon (basal). During the clamp, the dogs switched from net hepatic glucose output to uptake (rates reached 2.1 ± 1.2, 0.9 ± 2.1, 8.6 ± 2.3, and 6.0 ± 1.1 µmol ⋅ kg−1 ⋅ min−1 within 5 h in control, LY0.25, LY0.375, and LY0.5, respectively). Non-HGU in LY increased less than in control; the ratio of change from basal in non-HGU to change in net hepatic glucose balance, calculated when glucose infusion rates (GIRs) were ~20 µmol ⋅ kg-1 ⋅ min−1 in all groups, was higher in control (1.17 ± 0.38) versus LY0.25 (0.39 ± 0.33), LY0.375 (−0.01 ± 0.13), and LY0.5 (−0.09 ± 0.07). Likewise, the change from baseline in glucose Rd-to-Ra ratio was greatest in control (1.4 ± 0.3 vs. 0.6 ± 0.4, 0.5 ± 0.2, and 0.6 ± 0.2 in LY0.25, LY0.375, and LY0.5, respectively). In contrast to exogenously administered human insulin, LY demonstrated preferential hepatic effects, similar to endogenously secreted insulin. Therefore, the analog might reduce complications associated with current insulin therapy.

A Mathematical Model of the Oral Glucose Tolerance Test Illustrating the Effects of the Incretins

Despite important empirical findings, current models of the oral glucose tolerance test (OGTT) do not incorporate the essential contributions of the incretin hormones, glucagon-like peptide-1 and glucose-dependent insulinotropic peptide, to glucose-stimulated insulin secretion. In order to address this deficiency, a model was, therefore, developed in which the incretins, as well as a term reflecting net hepatic glucose balance, were included. Equations modeling the changes in incretins, hepatic glucose balance, insulin and glucose were used to simulate the responses to 50 and 100 g oral glucose loads under normal conditions. The model successfully captures main trends in mean data from the literature using a simple 'lumped-parameter,' single-compartment approach in which the majority of the parameters were matched to known clinical data. The accuracy of the model and its applicability to understanding fundamental mechanisms was further assessed using a variety of glycemic and insulinemic challenges beyond those which the model was originally created to encompass, including hyper- and hypoinsulinemia, changes in insulin sensitivity, and the insulin infusion-modified intravenous glucose tolerance test.

Selective antagonism of the hepatic glucocorticoid receptor reduces hepatic glucose production

A liver-selective glucocorticoid (GC) receptor antagonist (A-348441) was used to determine the effect of reduced hepatic GC signaling on hepatic glucose production. Fasted conscious dogs were studied in the presence (GRA, n = 6) or absence (CON, n = 6) of the intraduodenally administered GC receptor antagonist (100 mg/kg). All dogs were maintained on a pancreatic clamp and in a euglycemic state for 7 hours to ensure that any changes in glucose metabolism were the direct result of the effects of A-348441, which was given at the start of a 5-hour experimental period. In the GRA group, the arterial plasma insulin level was 4.6 ± 0.7 and 4.8 ± 0.6 μU/mL during the basal and the last 30 minutes of the experimental periods, respectively. In the CON group, it was 4.0 ± 0.3 and 4.5 ± 0.5 μU/mL in the 2 periods, respectively. The arterial plasma glucagon level was 49 ± 4 and 46 ± 3 pg/mL in the 2 periods in the GRA group, and 45 ± 3 and 42 ± 3 pg/mL in the CON group. Net hepatic glucose balance progressively decreased in the GRA group from 1.31 ± 0.18 to 0.49 ± 0.30 mg/kg per minute, whereas in the CON group, net hepatic glucose balance was 1.17 ± 0.09 and 1.43 ± 0.18 mg/kg per minute during the basal and last 30 minutes of the experimental periods, respectively. No significant change in net renal or gut glucose balance or nonhepatic glucose uptake was observed in either group. This study demonstrates that the GC receptor plays an important role in the regulation of basal hepatic glucose production and represents a significant potential therapeutic target.

Inclusion of low amounts of fructose with an intraportal glucose load increases net hepatic glucose uptake in the presence of relative insulin deficiency in dog

The effect of small amounts of fructose on net hepatic glucose uptake (NHGU) during hyperglycemia was examined in the presence of insulinopenia in conscious 42-h fasted dogs. During the study, somatostatin (0.8 microg.kg(-1).min(-1)) was given along with basal insulin (1.8 pmol.kg(-1).min(-1)) and glucagon (0.5 ng.kg(-1).min(-1)). After a control period, glucose (36.1 micromol.kg(-1).min(-1)) was continuously given intraportally for 4 h with (2.2 micromol.kg(-1).min(-1)) or without fructose. In the fructose group, the sinusoidal blood fructose level (nmol/ml) rose from <16 to 176 +/- 11. The infusion of glucose alone (the control group) elevated arterial blood glucose (micromol/ml) from 4.3 +/- 0.3 to 11.2 +/- 0.6 during the first 2 h after which it remained at 11.6 +/- 0.8. In the presence of fructose, glucose infusion elevated arterial blood glucose (micromol/ml) from 4.3 +/- 0.2 to 7.4 +/- 0.6 during the first 1 h after which it decreased to 6.1 +/- 0.4 by 180 min. With glucose infusion, net hepatic glucose balance (micromol.kg(-1).min(-1)) switched from output (8.9 +/- 1.7 and 13.3 +/- 2.8) to uptake (12.2 +/- 4.4 and 29.4 +/- 6.7) in the control and fructose groups, respectively. Average NHGU (micromol.kg(-1).min(-1)) and fractional glucose extraction (%) during last 3 h of the test period were higher in the fructose group (30.6 +/- 3.3 and 14.5 +/- 1.4) than in the control group (15.0 +/- 4.4 and 5.9 +/- 1.8). Glucose 6-phosphate and glycogen content (micromol glucose/g) in the liver and glucose incorporation into hepatic glycogen (micromol glucose/g) were higher in the fructose (218 +/- 2, 283 +/- 25, and 109 +/- 26, respectively) than in the control group (80 +/- 8, 220 +/- 31, and 41 +/- 5, respectively). In conclusion, small amounts of fructose can markedly reduce hyperglycemia during intraportal glucose infusion by increasing NHGU even when insulin secretion is compromised.

Characterization of the portal signal in a nonsteady hyperglycemic state in conscious dogs.

To characterize the "portal signal" in a nonsteady hyperglycemic state, the kinetic relationship between net hepatic glucose balance (NHGB) and either hepatic glucose load (HGL) or plasma insulin level was determined during glucose infusion using a catheter technique in 36 conscious dogs. Glucose was infused intraportally (Po group) and peripherally (Pe group) at 39, 56, and 83 micromol x kg(-1) x min(-1) over 2 h. There was a linear relationship between mean NHGB and either mean HGL or plasma insulin levels at each rate in either delivery (HGL: Po r = 0.99, Pe r = 0.95; insulin: Po r = 99, Pe r = 0.79). The threshold levels for net hepatic glucose uptake were 3.8 and 11.7 mmol/l for plasma glucose and 65 and 392 pmol/l for plasma insulin, respectively. The slope of the regression line against the abscissa was four times larger in portal than in peripheral delivery (HGL: Po 0.20 vs. Pe 0.05, P < 0.05; insulin: Po 0.19 vs. Pe 0.04, P < 0.05). These results suggest that the portal signal overrules the threshold of glucose for hepatic uptake by increasing hepatic extraction rate in a nonsteady hyperglycemic state.

Inclusion of low amounts of fructose with an intraduodenal glucose load markedly reduces postprandial hyperglycemia and hyperinsulinemia in the conscious dog.

Intraportal infusion of small amounts of fructose markedly augmented net hepatic glucose uptake (NHGU) during hyperglycemic hyperinsulinemia in conscious dogs. In this study, we examined whether the inclusion of catalytic amounts of fructose with a glucose load reduces postprandial hyperglycemia and the pancreatic beta-cell response to a glucose load in conscious 42-h-fasted dogs. Each study consisted of an equilibration (-140 to -40 min), control (-40 to 0 min), and test period (0-240 min). During the latter period, glucose (44.4 micromol x kg(-1) x min(-1)) was continuously given intraduodenally with (2.22 micromol x kg(-1) x min(-1)) or without fructose. The glucose appearance rate in portal vein blood was not significantly different with or without the inclusion of fructose (41.3 +/- 2.7 vs. 37.3 +/- 8.3 micromol x kg(-1) x min(-1), respectively). In response to glucose infusion without the inclusion of fructose, the net hepatic glucose balance switched from output to uptake (from 10 +/- 2 to 11 +/- 4 micromol x kg(-1) x min(-1)) by 30 min and averaged 17 +/- 6 micromol x kg(-1) x min(-1). The fractional extraction of glucose by the liver during the infusion period was 7 +/- 2%. Net glycogen deposition was 2.44 mmol glucose equivalent/kg body wt; 49% of deposited glycogen was synthesized via the direct pathway. Net hepatic lactate production was 1.4 mmol/kg body wt. Arterial blood glucose rose from 4.1 +/- 0.2 to 7.3 +/- 0.4 mmol/l, and arterial plasma insulin rose from 42 +/- 6 to 258 +/- 66 pmol/l at 30 min, after which they decreased to 7.0 +/- 0.5 mmol/l and 198 +/- 66 pmol/l, respectively. Arterial plasma glucagon decreased from 54 +/- 7 to 32 +/- 3 ng/l. In response to intraduodenal glucose infusion in the presence of fructose, net hepatic glucose balance switched from 9 +/- 1 micromol x kg(-1) x min(-1) output to 12 +/- 3 and 28 +/- 5 micromol x kg(-1) x min(-1) uptake by 15 and 30 min, respectively. The average NHGU (28 +/- 5 micromol x kg(-1) x min(-1)) and fractional extraction during infusion period (12 +/- 2%), net glycogen deposition (3.68 mmol glucose equivalent/kg body wt), net hepatic lactate production (3.27 mmol/kg), and glycogen synthesis via the direct pathway (68%) were significantly higher (P < 0.05) compared to that in the absence of fructose. The increases in arterial blood glucose (from 4.4 +/- 0.1 to 6.4 +/- 0.2 mmol/l at 30 min) and arterial plasma insulin (from 48 +/- 6 to 126 +/- 30 pmol/l at 30 min) were significantly smaller (P < 0.05). In summary, the inclusion of small amounts of fructose with a glucose load augmented NHGU, increased hepatic glycogen synthesis via the direct pathway, and augmented hepatic glycolysis. As a result, postprandial hyperglycemia and insulin release by the pancreatic beta-cell were reduced. In conclusion, catalytic amounts of fructose have the ability to improve glucose tolerance.

Prediction of a glucose appearance function from foods using deconvolution

The glycaemic response of an insulin-treated diabetic patient goes through many transitory phases, leading to a steady state glycaemic profile following a change in either insulin regimen or diet. Most models attempting to model the glucose and insulin relationship try to model the effect of oral or injected glucose rather than that from the digestion of food. However, it is clear that a better understanding of the glycaemic response would arise from consideration of intestinal absorption from the gut. It is assumed that this type of absorption can be modelled by a so-called glucose appearance function (systemic appearance of glucose via glucose absorption from the gut) predicting the glucose load from the food. Much research has been carried out in the areas of hepatic balance, insulin absorption and insulin independent/dependent utilization. However, little is known about intestinal absorption patterns or their corresponding glucose appearance profiles. The strategy under investigation herein is to use deconvolution or backward engineering. By starting with specific results i.e. blood glucose and insulin therapy, it is possible to work backwards to predict the glucose forcing functions responsible for the outcome. Assuming compartmental consistency, this will allow a clearer insight into the true gut absorption process. If successful, the same strategy can be applied to more recent glucose and insulin models to further our understanding of the food to blood glucose problem. This paper investigates the Lehmann-Deutsch modified model of glucose and insulin interaction, created from the model proposed by Berger-Rodbard. The model attempts to simulate the steady state glycaemic and plasma insulin responses, independent of the initial values from which the simulation is started. Glucose enters the model via both intestinal absorption and hepatic glucose production. We considered a 70 kg male insulin-dependent diabetic patient with corresponding hepatic and insulin sensitivity parameters of 0.6 and 0.3 respectively. Net hepatic glucose balance was modelled piecewise by linear and symmetric functions. A first-order Euler method with step size of 15 minutes was employed. For the simulation, only Actrapid and NPH injections were considered. The injection of insulin and the glucose flux to the gut were started simultaneously to avoid any delay associated with gastric emptying. The systemic appearance of glucose was compared from two view points, not only to assess the strategic principle, but also to assess the suitability of the modifications made by Lehmann and Deutsch. The first is a forward prediction using the compartmental structure. This analysis involves the rate of gastric emptying without time delay. The second is a backward prediction from experimentally observed blood glucose profiles. Investigations involved porridge, white rice and banana containing the same carbohydrate content (25 g). Results obtained from the first analysis were dependent on the rate of gastric emptying, especially its ascending and descending branches. Results from the second analysis were dependent on the dose and type of insulin administered. Both predicted profiles showed consistency with physiological reasoning, although it became apparent that such solutions could be unstable. Furthermore, both types of prediction were similar in structure and appearance, especially in simulations for porridge and banana. This emphasized the consistency and suitability of both analyses when investigating the compartmental accuracy and limitations within a model. The new strategic approach was deemed a success within the model, and the modifications made by Lehmann and Deutsch appropriate. We suggest that a gastric emptying curve with a possible gastric delay is the way forward in regulating the appearance of glucose via gut absorption. The Lehmann-Deutsch gastric curve is described by either a trapezoidal or triangular function dependent on the carbohydrate cont

Combined intraportal infusion of acetylcholine and adrenergic blockers augments net hepatic glucose uptake

Portal glucose delivery in the conscious dog augments net hepatic glucose uptake (NHGU). To investigate the possible role of altered autonomic nervous activity in the effect of portal glucose delivery, the effects of adrenergic blockade and acetylcholine (ACh) on hepatic glucose metabolism were examined in 42-h-fasted conscious dogs. Each study consisted of an equilibration (-120 to -20 min), a control (-20 to 0 min), and a hyperglycemic-hyperinsulinemic period (0 to 300 min). During the last period, somatostatin (0.8 microg. kg(-1). min(-1)) was infused along with intraportal insulin (1.2 mU. kg(-1). min(-1)) and glucagon (0.5 ng. kg(-1). min(-1)). Hepatic sinusoidal insulin was four times basal (73 +/- 7 microU/ml) and glucagon was basal (55 +/- 7 pg/ml). Glucose was infused peripherally (0-300 min) to create hyperglycemia (220 mg/dl). In test protocol, phentolamine and propranolol were infused intraportally at 0.2 microg and 0.1 microg. kg(-1). min(-1) from 120 min on. ACh was infused intraportally at 3 microg. kg(-1). min(-1) from 210 min on. In control protocol, saline was given in place of the blockers and ACh. Hyperglycemia-hyperinsulinemia switched the net hepatic glucose balance (mg. kg(-1). min(-1)) from output (2.1 +/- 0.3 and 1.1 +/- 0.2) to uptake (2.8 +/- 0.9 and 2.6 +/- 0.6) and lactate balance (micromol. kg(-1). min(-1)) from uptake (7.5 +/- 2.2 and 6.7 +/- 1.6) to output (3.7 +/- 2.6 and 3.9 +/- 1.6) by 120 min in the control and test protocols, respectively. Thereafter, in the control protocol, NHGU tended to increase slightly (3.0 +/- 0.6 mg. kg(-1). min(-1) by 300 min). In the test protocol, adrenergic blockade did not alter NHGU, but ACh infusion increased it to 4.4 +/- 0.6 and 4.6 +/- 0.6 mg. kg(-1). min(-1) by 220 and 300 min, respectively. These data are consistent with the hypothesis that alterations in nerve activity contribute to the increase in NHGU seen after portal glucose delivery.

Prediction of a glucose appearance function from foods using deconvolution

The glycaemic response of an insulin-treated diabetic patient goes through many transitory phases, leading to a steady state glycaemic profile following a change in either insulin regimen or diet. Most models attempting to model the glucose and insulin relationship try to model the effect of oral or injected glucose rather than that from the digestion of food. However, it is clear that a better understanding of the glycaemic response would arise from consideration of intestinal absorption from the gut. It is assumed that this type of absorption can be modelled by a so-called glucose appearance function (systemic appearance of glucose via glucose absorption from the gut) predicting the glucose load from the food. Much research has been carried out in the areas of hepatic balance, insulin absorption and insulin independent/dependent utilization. However, little is known about intestinal absorption patterns or their corresponding glucose appearance profiles. The strategy under investigation herein is to use deconvolution or backward engineering. By starting with specific results i.e. blood glucose and insulin therapy, it is possible to work backwards to predict the glucose forcing functions responsible for the outcome. Assuming compartmental consistency, this will allow a clearer insight into the true gut absorption process. If successful, the same strategy can be applied to more recent glucose and insulin models to further our understanding of the food to blood glucose problem. This paper investigates the Lehmann-Deutsch modified model of glucose and insulin interaction, created from the model proposed by Berger-Rodbard. The model attempts to simulate the steady state glycaemic and plasma insulin responses, independent of the initial values from which the simulation is started. Glucose enters the model via both intestinal absorption and hepatic glucose production. We considered a 70 kg male insulin-dependent diabetic patient with corresponding hepatic and insulin sensitivity parameters of 0.6 and 0.3 respectively. Net hepatic glucose balance was modelled piecewise by linear and symmetric functions. A first-order Euler method with step size of 15 minutes was employed. For the simulation, only Actrapid and NPH injections were considered. The injection of insulin and the glucose flux to the gut were started simultaneously to avoid any delay associated with gastric emptying. The systemic appearance of glucose was compared from two view points, not only to assess the strategic principle, but also to assess the suitability of the modifications made by Lehmann and Deutsch. The first is a forward prediction using the compartmental structure. This analysis involves the rate of gastric emptying without time delay. The second is a backward prediction from experimentally observed blood glucose profiles. Investigations involved porridge, white rice and banana containing the same carbohydrate content (25 g). Results obtained from the first analysis were dependent on the rate of gastric emptying, especially its ascending and descending branches. Results from the second analysis were dependent on the dose and type of insulin administered. Both predicted profiles showed consistency with physiological reasoning, although it became apparent that such solutions could be unstable. Furthermore, both types of prediction were similar in structure and appearance, especially in simulations for porridge and banana. This emphasized the consistency and suitability of both analyses when investigating the compartmental accuracy and limitations within a model. The new strategic approach was deemed a success within the model, and the modifications made by Lehmann and Deutsch appropriate. We suggest that a gastric emptying curve with a possible gastric delay is the way forward in regulating the appearance of glucose via gut absorption. The Lehmann-Deutsch gastric curve is described by either a trapezoidal or triangular function dependent on the carbohydrate cont

Role of a negative arterial-portal venous glucose gradient in the postexercise state

Prior exercise stimulates muscle and liver glucose uptake. A negative arterial-portal venous glucose gradient (a-pv grad) stimulates resting net hepatic glucose uptake (NHGU) but reduces muscle glucose uptake. This study investigates the effects of a negative a-pv grad during glucose administration after exercise in dogs. exercise (-180 to -30 min), transition (-30 to -20 min), basal period (-20 to 0 min), and experimental period (0 to 100 min). In the experimental period, 130 mg/dl arterial hyperglycemia was induced via vena cava (Pe, n = 6) or portal vein (Po, n = 6) glucose infusions. Insulin and glucagon were replaced at fourfold basal and basal rates. During the experimental period, the a-pv grad (mg/dl) was 3 +/- 1 in Pe and -10 +/- 2 in Po. Arterial insulin and glucagon were similar in the two groups. In Pe, net hepatic glucose balance (mg x kg(-1) x min(-1), negative = uptake) was 4.2 +/- 0.3 (basal period) and -1.2 +/- 0.3 (glucose infusion); in Po it was 4.1 +/- 0.5 and -3.2 +/- 0.4, respectively (P < 0.005 vs. Pe). Total glucose infusion (mg x kg(-1) x min(-1)) was 11 +/- 1 in Po and 8 +/- 1 in Pe (P < 0.05). Net hindlimb and whole body nonhepatic glucose uptakes were similar. the portal signal independently stimulates NHGU after exercise. Conversely, prior exercise eliminates the inhibitory effect of the portal signal on glucose uptake by nonhepatic tissues. The portal signal therefore increases whole body glucose disposal after exercise by an amount equal to the increase in NHGU.

Prior exercise increases net hepatic glucose uptake during a glucose load.

The aim of these studies was to determine whether prior exercise enhances net hepatic glucose uptake (NHGU) during a glucose load. Sampling catheters (carotid artery, portal, hepatic, and iliac veins), infusion catheters (portal vein and vena cava), and Doppler flow probes (portal vein, hepatic and iliac arteries) were implanted. Exercise (150 min; n = 6) or rest (n = 6) was followed by a 30-min control period and a 100-min experimental period (3.5 mg. kg-1. min-1 of glucose in portal vein and as needed in vena cava to clamp arterial blood glucose at approximately 130 mg/dl). Somatostatin was infused, and insulin and glucagon were replaced intraportally at fourfold basal and basal rates, respectively. During experimental period the arterial-portal venous (a-pv) glucose gradient (mg/dl) was -18 +/- 1 in sedentary and -19 +/- 1 in exercised dogs. Arterial insulin and glucagon were similar in the two groups. Net hepatic glucose balance (mg. kg-1. min-1) shifted from 1.9 +/- 0.2 in control period to -1.8 +/- 0.2 (negative rates represent net uptake) during experimental period in sedentary dogs (Delta3.7 +/- 0.5); with prior exercise it shifted from 4.1 +/- 0.3 (P < 0.01 vs. sedentary) in control period to -3.2 +/- 0.4 (P < 0.05 vs. sedentary) during experimental period (Delta7.3 +/- 0.7, P < 0.01 vs. sedentary). Net hindlimb glucose uptake (mg/min) was 4 +/- 1 in sedentary animals in control period and 13 +/- 2 during experimental period; in exercised animals it was 7 +/- 1 in control period (P < 0. 01 vs. sedentary) and 32 +/- 4 (P < 0.01 vs. sedentary) during experimental period. As the total glucose infusion rate (mg. kg-1. min-1) was 7 +/- 1 in sedentary and 11 +/- 1 in exercised dogs, approximately 30% of the added glucose infusion due to prior exercise could be accounted for by the greater NHGU. In conclusion, when determinants of hepatic glucose uptake (insulin, glucagon, a-pv glucose gradient, glycemia) are controlled, prior exercise increases NHGU during a glucose load due to an effect that is intrinsic to the liver. Increased glucose disposal in the postexercise state is therefore due to an improved ability of both liver and muscle to take up glucose.

Effect of fast duration on disposition of an intraduodenal glucose load in the conscious dog.

The effects of prior fast duration (18 h, n = 8; 42 h, n = 8) on the glycemic and tissue-specific responses to an intraduodenal glucose load were studied in chronically catheterized conscious dogs. [3-3H]glucose was infused throughout the study. After basal measurements, glucose spiked with [U-14C]glucose was infused for 150 min intraduodenally. Arterial insulin and glucagon were similar in the two groups. Arterial glucose (mg/dl) rose approximately 70% more during glucose infusion after 42 h than after an 18-h fast. The net hepatic glucose balance (mg. kg-1. min-1) was similar in the two groups (basal: 1.8 +/- 0.2 and 2.0 +/- 0.3; glucose infusion: -2.2 +/- 0.5 and -2.2 +/- 0.7). The intrahepatic fate of glucose was 79% glycogen, 13% oxidized, and 8% lactate release after a 42-h fast; it was 23% glycogen, 21% oxidized, and 56% lactate release after an 18-h fast. Net hindlimb glucose uptake was similar between groups. The appearance of intraduodenal glucose during glucose infusion (mg/kg) was 900 +/- 50 and 1,120 +/- 40 after 18- and 42-h fasts (P < 0.01). glucose administration after prolonged fasting induces higher circulating glucose than a shorter fast (increased appearance of intraduodenal glucose); liver and hindlimb glucose uptakes and the hormonal response, however, are unchanged; finally, an intrahepatic redistribution of carbons favors glycogen deposition.

Small amounts of fructose markedly augment net hepatic glucose uptake in the conscious dog.

Fructose activates glucokinase by releasing the enzyme from its inhibitory protein in liver. To examine the importance of acute activation of glucokinase in regulating hepatic glucose uptake, the effect of intraportal infusion of a small amount of fructose on net hepatic glucose uptake (NHGU) was examined in 42 h-fasted conscious dogs. Isotopic ([3-3H] and [U-14C]glucose) and arteriovenous difference methods were used. Each study consisted of an equilibration period (-90 to -30 min), a control period (-30 to 0 min), and a hyperglycemic/hyperinsulinemic period (0-390 min). During the latter period, somatostatin (489 pmol x kg(-1) x min(-1)) was given, along with intraportal insulin (7.2 pmol x kg(-1) x min(-1)) and glucagon (0.5 ng x kg(-1) x min(-1)). In this way, the liver sinusoidal insulin level was fixed at four times basal (456 +/- 60 pmol/l), and liver sinusoidal glucagon level was kept basal (46 +/- 6 ng/l). Glucose was infused through a peripheral vein to create hyperglycemia (12.5 mmol/l plasma). Hyperglycemic hyperinsulinemia (no fructose) switched net hepatic glucose balance (micromoles per kilogram per minute) from output (11.3 +/- 1.4) to uptake (14.7 +/- 1.7) and net lactate balance (micromoles per kilogram per minute) from uptake (6.5 +/- 2.1) to output (4.4 +/- 1.5). Fructose was infused intraportally at a rate of 1.7, 3.3, or 6.7 micromol x kg(-1) x min(-1), starting at 120, 210, or 300 min, respectively. In the three periods, portal blood fructose increased from <6 to 113 +/- 14, 209 +/- 29, and 426 +/- 62 micromol/l, and net hepatic fructose uptake increased from 0.03 +/- 0.01 to 1.3 +/- 0.4, 2.3 +/- 0.7, and 5.1 +/- 0.6 micromol x kg(-1) x min(-1), respectively. NHGU increased to 41 +/- 3, 54 +/- 5, and 69 +/- 8 micromol x kg(-1) x min(-1), respectively, and net hepatic lactate output increased to 11.0 +/- 3.2, 15.3 +/- 2.7, and 22.4 +/- 2.8 micromol x kg(-1) x min(-1) in the three fructose periods, respectively. The amount of [3H]glucose incorporated into glycogen was equivalent to 69 +/- 3% of [3H]glucose taken up by the liver. These data suggest that glucokinase translocation within the hepatocyte is a major determinant of hepatic glucose uptake by the dog in vivo.

Autoregulation of hepatic glucose production.

In vitro evidence indicates that the liver responds directly to changes in circulating glucose concentrations with reciprocal changes in glucose production and that this autoregulation plays a role in maintenance of normoglycemia. Under in vivo conditions it is difficult to separate the effects of glucose on neural regulation mediated by the central nervous system from its direct effect on the liver. Nevertheless, it is clear that nonhormonal mechanisms can cause significant changes in net hepatic glucose balance. In response to hyperglycemia, net hepatic glucose output can be decreased by as much as 60-90% by nonhormonal mechanisms. Under conditions in which hepatic glycogen stores are high (i.e. the overnight-fasted state), a decrease in the glycogenolytic rate and an increase in the rate of glucose cycling within the liver appear to be the explanation for the decrease in hepatic glucose output seen in response to hyperglycemia. During more prolonged fasting, when glycogen levels are reduced, a decrease in gluconeogenesis may occur as a part of the nonhormonal response to hyperglycemia. A substantial role for hepatic autoregulation in the response to insulin-induced hypoglycemia is most clearly evident in severe hypoglycemia (< or = 2.8 mmol/l). The nonhormonal response to hypoglycemia apparently involves enhancement of both gluconeogenesis and glycogenolysis and is capable of supplying enough glucose to meet at least half of the requirement of the brain. The nonhormonal response can include neural signaling, as well as autoregulation. However, even in the absence of the ability to secrete counterregulatory hormones (glucocorticoids, catecholamines, and glucagon), dogs with denervated livers (to interrupt neural pathways between the liver and brain) were able to respond to hypoglycemia with increases in net hepatic glucose output. Thus, even though the endocrine system provides the primary response to changes in glycemia, autoregulation plays an important adjunctive role.

Hepatic glucose-6-phosphatase flux and glucose phosphorylation, cycling, irreversible disposal, and net balance in vivo in rats. Measurement using the secreted glucuronate technique

Measurement of hepatic glucose production (HGP) by standard isotope dilution reveals only the net release of glucose from the liver, not the flux across glucose-6-phosphatase ([G6Pase] or total hepatic glucose output), hepatic glucose cycling (HGC), irreversible glucose disposal into glycogen in the liver (hepatic Rd), or net hepatic glucose balance. We describe two independent isotopic techniques for measuring these parameters in vivo, both of which use secreted glucuronate (GlcUA), HGC can be quantified by measuring a correction factor for glucose label retained in hepatic glucose-6-phosphate (G6P), sampled as GlcUA. A complementary technique for measuring total hepatic glucose output is also described (reverse dilution), requiring administration of no labeled glucose but instead a labeled gluconeogenic precursor and unlabeled glucose. Hepatic Rd is calculated by multiplying the rate of appearance (Ra) of hepatic UDP-glucose ([UDP-glc] based on dilution of labeled galactose in GlcUA) times the direct entry of glucose into hepatic UDP-glc and the fraction of labeled UDP-glc retained in the liver. The sum of hepatic Rd plus HGC represents the total hepatic glucose phosphorylation rate. Rats received intravenous (IV) glucose infusions at a rate of 15 to 30 mg/kg/min after a 24-hour fast. Despite a suppression of net HGP more than 50%, total hepatic glucose output was not significantly decreased, because of increased HGC. Total hepatic glucose output calculated by reverse dilution yielded similar results during IV glucose infusions at 15 mg/kg/min, although values were higher than obtained by the correction-factor method at 30 mg/kg/min. The fraction of labeled UDP-glc released into blood glucose, representing a hepatic glycogen cycle, decreased from 35% (fasted) to nearly 0% (IV glucose 30 mg/kg/min). Hepatic Rd was 1.4, 4.6, and 7.5 mg/kg/min (fasted and IV glucose 15 and 30 mg/kg/min, respectively); total hepatic glucose phosphorylation increased substantially (from 4.2 to 8.5 to 12.7 mg/kg/min) and net hepatic glucose balance changed from negative to positive during IV glucose. In conclusion, hepatic G6Pase flux, glucose phosphorylation, HGC, disposal of glucose into glycogen, and net glucose balance can be measured noninvasively in vivo under various metabolic conditions by techniques involving the GlcUA probe.

Influence of oral sulfonylurea agents on hepatic glucose uptake

Although the metabolic derangement in the subjects with well-established NIDDM is characterized by both insulin resistance and diminished insulin secretion, the impaired sensitivity to insulin in the target tissues is assumed to represent the primary defect in most NIDDM individuals. Therefore, the therapeutic modality that can augment insulin-mediated glucose metabolism in the target tissues seems rational in the treatment of NIDDM. Glimepiride (HOE490), a newly developed sulfonylurea, has been reported to have a more potent hypoglycemic action than glibenclamide while its ability to stimulate insulin secretion is much weaker. Thus, part of the potent hypoglycemic action of HOE490 has been speculated as being due to an extrapancreatic effect. First we examined the effect of strict glycemic control on insulin resistance seen in NIDDM using euglycemic hyperinsulinemic clamp combined with oral glucose loading (Clamp-OGL) to 9 subjects with NIDDM. After 3 to 4 weeks of intensified insulin therapy, insulin-mediated glucose uptake by the liver significantly increased while peripheral glucose disposal did not change. Secondly we applied Clamp-OGL to 5 subjects with IDDM to study the acute metabolic effect of HOE490 on glucose handlings by the target tissues. Intravenous administration of HOE490 at a rate of 6.0 μg/min did not affect hepatic glucose uptake in these subjects. Thus we studied subacute metabolic effect of HOE490 on glucose handlings by the target tissues in 7 normal dogs using euglycemic clamp combined with hepatic venous catheterization technique. After 7-day consecutive oral administration of HOE490 (0.1 mg/kg/day), net hepatic glucose balance during portal glucose infusion showed a marked elevation and this explained most of the increment in the systemic glucose utilization. These results indicate that rather short-term oral administration of HOE490 has a stimulatory effect on the insulin-mediated glucose uptake predominantly by the liver when glucose is loaded via a physiological route. Whether HOE490 has similar effect on the hepatic glucose disposal in the subjects with NIDDM, should be examined.