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Adams JD, Treiber G, Hurtado MD, Laurenti MC, Dalla Man C, Cobelli C, Rizza RA, Vella A. Increased Rates of Meal Absorption Do Not Explain Elevated 1-Hour Glucose in Subjects With Normal Glucose Tolerance. J Endocr Soc 2018; 3:135-145. [PMID: 30591957 PMCID: PMC6302905 DOI: 10.1210/js.2018-00222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/16/2018] [Indexed: 01/12/2023] Open
Abstract
Context In subjects with normal fasting glucose (NFG) and normal glucose tolerance (NGT), glucose concentrations >155 mg/dL 1 hour after 75 g of oral glucose predict increased risk of progression to diabetes. Recently, it has been suggested that the mechanism underlying this abnormality is increased gut absorption of glucose. Objective We sought to determine the rate of systemic appearance of meal-derived glucose in subjects classified by their 1-hour glucose after a 75-g oral glucose challenge. Design This was a cross-sectional study. Participating subjects underwent a 75-g oral glucose challenge and a labeled mixed meal test. Setting An inpatient clinical research unit at an academic medical center. Participants Thirty-six subjects with NFG/NGT participated in this study. Interventions Subjects underwent an oral glucose tolerance test. Subsequently, they underwent a labeled mixed meal to measure fasting and postprandial glucose metabolism. Main Outcome Measures We examined β-cell function and the rate of meal appearance (Meal Ra) in NFG/NGT subjects. Subsequently, we examined the relationship of peak postchallenge glucose with Meal Ra and indices of β-cell function. Results Peak glucose concentrations correlated inversely with β-cell function. No relationship of Meal Ra with peak postchallenge glucose concentrations was observed. Conclusion In subjects with NFG/NGT, elevated 1-hour peak postchallenge glucose concentrations reflect impaired β-cell function rather than increased systemic meal appearance.
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Affiliation(s)
- J D Adams
- Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Gerlies Treiber
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Maria Daniela Hurtado
- Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Marcello C Laurenti
- Department of Information Engineering, Università di Padova, 36131 Padova, Italy
| | - Chiara Dalla Man
- Department of Information Engineering, Università di Padova, 36131 Padova, Italy
| | - Claudio Cobelli
- Department of Information Engineering, Università di Padova, 36131 Padova, Italy
| | - Robert A Rizza
- Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Adrian Vella
- Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, Minnesota
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Aba PE. Evaluation of hepatic glycogen content, some haematological and biochemical parameters of alloxan-induced diabetic rats treated with combinations of glibenclamide and G. latifolium extract. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2017; 14:/j/jcim.2017.14.issue-4/jcim-2016-0078/jcim-2016-0078.xml. [PMID: 29345438 DOI: 10.1515/jcim-2016-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 03/21/2017] [Indexed: 11/15/2022]
Abstract
Background Diabetes is associated with both biochemical and haematological complications. Combination therapy has been advocated to mitigate some of these complications. Aim This study was designed to investigate the effects of glibenclamide and Gongronema latifolium (GL) on hepatic glycogen content and haemato-biochemical parameters. Methods Thirty male Wistar rats were assigned into five groups of six rats each. Groups 2-5 rats received intraperitoneally, 160 mg/kg of alloxan monohydrate while group 1 rats served as normal control. Groups 2-5 rats were respectively treated with 10 mL/kg distilled water (DW), 2 mg/kg glibenclamide, 200 mg/kg GL and 2 mg/kg glibenclamide and 200 mg/kg GL, while group 1 rats received 10 mL/kg DW. All treatments were per os daily for 21 days. Blood samples for investigation of haemato-biochemical (red blood cell [RBC], packed cell volume [PCV], haemoglobin concentration [Hb], blood urea nitrogen [BUN] and creatinine) parameters were collected on days 7, 14 and 21 post-treatment (PT), while the liver sample for hepatic glycogen determination was obtained on day 21 PT. Results Creatinine and BUN values of groups 3 and 4 rats were comparable to that of group 1 but were significantly (p<0.05) lower when compared with those of groups 2 and 5. There were significant (p<0.05) increases in the mean hepatic glycogen content, RBC, PCV, and Hb of group 4 rats when compared to those of group 2. Conclusions It was concluded that a combination of glibenclamide and G. latifolium in treatment of diabetic rats improved glycogen storage and demonstrated beneficial effects on haematology and kidney marker parameters.
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Abstract
Gluconeogenesis is a complex metabolic process that involves multiple enzymatic steps regulated by myriad factors, including substrate concentrations, the redox state, activation and inhibition of specific enzyme steps, and hormonal modulation. At present, the most widely accepted technique to determine gluconeogenesis is by measuring the incorporation of deuterium from the body water pool into newly formed glucose. However, several techniques using radioactive and stable-labeled isotopes have been used to quantitate the contribution and regulation of gluconeogenesis in humans. Each method has its advantages, methodological assumptions, and set of propagated errors. In this review, we examine the strengths and weaknesses of the most commonly used stable isotopes methods to measure gluconeogenesis in vivo. We discuss the advantages and limitations of each method and summarize the applicability of these measurements in understanding normal and pathophysiological conditions.
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Affiliation(s)
- Stephanie T Chung
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Shaji K Chacko
- U.S. Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Agneta L Sunehag
- U.S. Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Morey W Haymond
- U.S. Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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Relationship of muscle sympathetic nerve activity to insulin sensitivity. Clin Auton Res 2014; 24:77-85. [PMID: 24577625 DOI: 10.1007/s10286-014-0235-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 02/11/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE An association between insulin resistance and activation of the sympathetic nervous system has been reported in previous studies. However, potential interactions between insulin sensitivity and sympathetic neural mechanisms in healthy people remain poorly understood. We conducted a study to determine the relationship between sympathetic activity and insulin resistance in young, healthy humans. METHODS Thirty-seven healthy adults (18-35 years, BMI <28 kg m(-2)) were studied. Resting muscle sympathetic nerve activity (MSNA) was measured with microneurography and insulin sensitivity of glucose and free fatty acid metabolism was measured during a hyperinsulinemic-euglycemic clamp with two levels of insulin. RESULTS During lower doses of insulin, we found a small association between lower insulin sensitivity and higher MSNA (P < 0.05) but age was a cofactor in this relationship. Overall, we found no difference in insulin sensitivity between groups of low and high MSNA, but when women were analyzed separately, insulin sensitivity was lower in the high MSNA group compared with the low MSNA group of women. CONCLUSIONS These data suggest that MSNA and insulin sensitivity are only weakly associated with young healthy individuals and that age and sex may be important modifiers of this relationship.
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Curry TB, Roberts SK, Basu R, Basu A, Schroeder D, Joyner MJ, Miles JM. Gastric bypass surgery is associated with near-normal insulin suppression of lipolysis in nondiabetic individuals. Am J Physiol Endocrinol Metab 2011; 300:E746-51. [PMID: 21304064 PMCID: PMC3074944 DOI: 10.1152/ajpendo.00596.2010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We hypothesized that individuals who have undergone gastric bypass have greater insulin sensitivity that obese subjects but less compared with lean. We measured free fatty acid (FFA) and glucose kinetics during a two-step, hyperinsulinemic euglycemic clamp in nondiabetic subjects who were 38 ± 5 mo post-gastric bypass surgery (GB; n = 15), in lean subjects (L; n = 15), and in obese subjects (O; n = 16). Fasting FFAa were not significantly different between the three study groups but during both doses of insulin were significantly higher in O than in either GB or L. The effective insulin concentration resulting in half-maximal suppression of FFA was similar in L and GB and significantly less in both groups compared with O. Glucose infusion rates during low-dose insulin were not significantly different in GB compared with either L or O. During high-dose insulin, glucose infusion rates were significantly greater in GB than in O but less than in L. Endogenous glucose production in GB was significantly lower than O only during low dose of insulin. We conclude that gastric bypass is associated with improvements in adipose tissue insulin sensitivity to levels similar to lean, healthy persons and also with improvements in the response of glucose metabolism to insulin. These changes may be due to preferential reduction in visceral fat and decreased FFA availability. However, some differences in insulin sensitivity in GB remain compared with L. Residual insulin resistance may be related to excess total body fat or abnormal lipolysis and requires further study.
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Affiliation(s)
- Timothy B Curry
- Depts. of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
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Basu R, Barosa C, Basu A, Pattan V, Saad A, Jones J, Rizza R. Transaldolase exchange and its effects on measurements of gluconeogenesis in humans. Am J Physiol Endocrinol Metab 2011; 300:E296-303. [PMID: 21062960 PMCID: PMC3043622 DOI: 10.1152/ajpendo.00403.2010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The deuterated water method is used extensively to measure gluconeogenesis in humans. This method assumes negligible exchange of the lower three carbons of fructose 6-phsophate via transaldolase exchange since this exchange will result in enrichment of carbon 5 of glucose in the absence of net gluconeogenesis. The present studies tested this assumption. ²H₂O and acetaminophen were ingested and [1-¹³C]acetate infused in 11 nondiabetic subjects after a 16-h fast. Plasma and urinary glucuronide enrichments were measured using nuclear magnetic resonance spectroscopy before and during a 0.35 mU·kg FFM⁻¹·min⁻¹ insulin infusion. Rates of endogenous glucose production measured with [3-³H]- and [6,6-²H₂]glucose did not differ either before (14.0 ± 0.7 vs. 13.8 ± 0.7 μmol·kg⁻¹·min⁻¹) or during the clamp (10.4 ± 0.9 vs. 10.9 ± 0.7 μmol·kg⁻¹·min⁻¹), consistent with equilibration and quantitative removal of tritium during triose isomerase exchange. Plasma [3-¹³C] glucose-to-[4-¹³C]glucose and urinary [3-¹³C] glucuronide-to-[4-¹³C]glucuronide ratios were <1.0 (P < 0.001) in all subjects both before (0.66 ± 0.04 and 0.60 ± 0.04) and during (059 ± 0.05 and 0.56 ± 0.06) the insulin infusion, respectively, indicating that ∼35-45% of the labeling of the 5th carbon of glucose by deuterium was due to transaldolase exchange rather than gluconeogenesis. When corrected for transaldolase exchange, rates of gluconeogenesis were lower (P < 0.001) and glycogenolysis higher (P < 0.001) than uncorrected rates both before and during the insulin infusion. In conclusion, assuming negligible dilution by glycerol and near-complete triose isomerase equilibration, these data provide strong experimental evidence that transaldolase exchange occurs in humans, resulting in an overestimate of gluconeogenesis and an underestimate of glycogenolysis when measured with the ²H₂O method. Use of appropriate ¹³C tracers provides a means of correcting for transaldolase exchange.
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Affiliation(s)
- Rita Basu
- Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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Vella A, Rizza RA. Application of isotopic techniques using constant specific activity or enrichment to the study of carbohydrate metabolism. Diabetes 2009; 58:2168-74. [PMID: 19794073 PMCID: PMC2750215 DOI: 10.2337/db09-0318] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Adrian Vella
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.
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Vella A, Shah P, Basu A, Rizza RA. Prandial insulin and the systemic appearance of meal-derived glucose in people with type 1 diabetes. Diabetes Care 2008; 31:2230-1. [PMID: 18955720 PMCID: PMC2571049 DOI: 10.2337/dc08-1549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Adrian Vella
- From the Division of Endocrinology & Metabolism, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Pankaj Shah
- From the Division of Endocrinology & Metabolism, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ananda Basu
- From the Division of Endocrinology & Metabolism, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robert A. Rizza
- From the Division of Endocrinology & Metabolism, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Urita Y, Domon K, Ishihara S, Nanami M, Yanagisawa T, Okubo R, Sawa T, Watanabe T, Akimoto T, Kato H, Hara N, Honda Y, Nagai Y, Nakanishi K, Shimada N, Sugimoto M, Miki K. DIFFUSE WHITE DEPOSITS OF THE DUODENUM MAY SUGGEST DELAYED GLUCOSE ABSORPTION. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.2007.00704.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Abstract
BACKGROUND A simulation model of the glucose-insulin system in normal life conditions can be very useful in diabetes research, e.g., testing insulin infusion algorithms and decision support systems and assessing glucose sensor performance and patient and student training. A new meal simulation model has been proposed that incorporates state-of-the-art quantitative knowledge on glucose metabolism and its control by insulin at both organ/tissue and whole-body levels. This article presents the interactive simulation software GIM (glucose insulin model), which implements this model. METHODS The model is implemented in MATLAB, version 7.0.1, and is designed with a windows interface that allows the user to easily simulate a 24-hour daily life of a normal, type 2, or type 1 diabetic subject. A Simulink version is also available. Three meals a day are considered. Both open- and closed-loop controls are available for simulating a type 1 diabetic subject. RESULTS Software options are described in detail. Case studies are presented to illustrate the potential of the software, e.g., compare a normal subject vs an insulin-resistant subject or open-loop vs closed-loop insulin infusion in type 1 diabetes treatment. CONCLUSIONS User-friendly software that implements a state-of-the-art physiological model of the glucose-insulin system during a meal has been presented. The GIM graphical interface makes its use extremely easy for investigators without specific expertise in modeling.
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Affiliation(s)
- Chiara Dalla Man
- Department of Information Engineering, University of Padova, I-35131 Padova, Italy
| | - Davide M. Raimondo
- Dipartimento di Informatica e Sistemistica, University of Pavia, 27100 Pavia, Italy
| | - Robert A. Rizza
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Rochester, Minnesota
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, I-35131 Padova, Italy
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Féry F, Tappy L, Schneiter P, Devière J, Balasse EO. Effect of somatostatin on duodenal glucose absorption in man. J Clin Endocrinol Metab 2005; 90:4163-9. [PMID: 15827105 DOI: 10.1210/jc.2004-1766] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE The hyperglycemic hyperinsulinemic clamp technique using intraduodenally infused glucose is an attractive tool for studying postprandial glucose metabolism under strictly controlled conditions. Because it requires the use of somatostatin (SST), we examined, in this study, the effect of SST on intestinal glucose absorption. CONTEXT Twenty-six normal volunteers were given a constant 3-h intraduodenal infusion of glucose (6 mg.kg(-1).min(-1)) labeled with [2-(3)H]glucose for glucose absorption measurement. During glucose infusion, 19 subjects received iv SST at doses of 10-100 ng.kg(-1).min(-1) plus insulin and glucagon, and seven subjects were studied under control conditions. In the controls, glucose was absorbed at a rate that, after a 20-min lag period, equaled the infusion rate. RESULTS With all the doses of SST tested, absorption was considerably delayed but equaled the rate of infusion after 3 h. At that time, only 5 +/- 2% of the total amount of infused glucose was unabsorbed in the control subjects vs. 36 +/- 2% (P < 0.001) in the SST-infused subjects. In the latter, the intraluminal residue was almost totally absorbed within 40 min of the cessation of SST infusion. At the lowest dose of SST tested (10 ng.kg(-1).min(-1)), suppression of insulin secretion was incomplete. CONCLUSION These properties of SST hamper the use of intraduodenal hyperglycemic hyperinsulinemic clamps as a tool for exploring postprandial glucose metabolism.
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Affiliation(s)
- Francoise Féry
- Laboratory of Experimental Medicine and Department of Endocrinology, Hôpital Erasme, University of Brussels, Brussels, Belgium.
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Abstract
PURPOSE OF REVIEW The development of incretin hormones and incretin analogues for the therapy of diabetes highlights the importance of the gastrointestinal tract in the maintenance of glucose tolerance. RECENT FINDINGS The review focuses on recent information on the role of incretins and their breakdown products on insulin secretion, gastric emptying, and satiety. The importance of gastric emptying and its absorptive potential as well as of dietary composition on gastric emptying and glucose tolerance is highlighted. The concept of a portal glucose sensor in humans has been the subject of some controversy but has been recently revisited. SUMMARY The gastrointestinal tract plays an important part in glucose tolerance. In this review we have examined how factors altering gastric emptying, insulin secretion in response to meal ingestion, and gastric emptying contribute to the maintenance and deterioration of glucose tolerance.
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Affiliation(s)
- Adrian Vella
- Division of Endocrinology & Metabolism, Department of Medicine, Mayo Clinic & Foundation, 200 First ST SW, Rochester, MN 55905, USA.
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Rayner CK, Schwartz MP, van Dam PS, Renooij W, de Smet M, Horowitz M, Wishart JM, Smout AJPM, Samsom M. Upper gastrointestinal responses to intraduodenal nutrient in type 1 diabetes mellitus. Eur J Gastroenterol Hepatol 2004; 16:183-9. [PMID: 15075992 DOI: 10.1097/00042737-200402000-00010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Abnormal nutrient-related small-intestinal feedback may contribute to disordered gastric motility and upper gastrointestinal symptoms in patients with diabetes. AIM To evaluate the motor, sensory and incretin responses to intraduodenal nutrients in patients with type 1 diabetes and in controls. METHODS Eight type 1 diabetes patients (two with autonomic neuropathy) and nine controls were studied during euglycaemia. A manometric catheter was positioned across the pylorus, and nutrient was infused intraduodenally (90 kcal over 30 min). Blood glucose and plasma glucagon-like peptide 1 and gastric inhibitory polypeptide were measured, and sensations were assessed with visual analogue questionnaires. RESULTS During nutrient infusion, neither the number of antral waves nor the stimulation of phasic or basal pyloric pressures differed between patients and controls. Upper gut sensations and areas under the plasma incretin peptide curves did not differ between the groups. CONCLUSIONS During euglycaemia, the upper gastrointestinal motor, sensory and incretin peptide responses to small-intestinal nutrient are comparable in patients with relatively uncomplicated type 1 diabetes and in healthy subjects.
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Féry F, Tappy L, Devière J, Balasse EO. Comparison of intraduodenal and intravenous glucose metabolism under clamp conditions in humans. Am J Physiol Endocrinol Metab 2004; 286:E176-83. [PMID: 14532166 DOI: 10.1152/ajpendo.00201.2003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
To determine whether the uptake and metabolic partition of glucose are influenced by its delivery route, 12 normal volunteers underwent two 3-h euglycemic (approximately 93 mg/dl) hyperinsulinemic (approximately 43 mU/l) clamps at a 3- to 5-wk interval, one with intravenous (i.v.) and the other with intraduodenal (i.d.) glucose labeled with [3-3H]- and [U-14C]glucose. Systemic glucose was traced with [6,6-2H2]glucose in eight subjects. During the last hour of the clamps, the average glucose infusion rate (5.85 +/- 0.37 vs. 5.43 +/- 0.43 mg.kg(-1).min(-1); P = 0.02) and exogenous glucose uptake (5.66 +/- 0.37 vs. 5.26 +/- 0.41 mg.kg(-1).min(-1); P = 0.04) were borderline higher in the i.d. than in the i.v. studies. The increased uptake was entirely accounted for by increased glycolysis (3H2O production), which was attributed to the stimulation of gut metabolism by the absorptive process. No difference was observed in glucose storage whether it was calculated as glucose uptake minus glycolysis (i.d. vs. i.v.: 2.44 +/- 0.28 vs. 2.40 +/- 0.31 mg.kg(-1).min(-1)) or as glucose uptake minus net glucose oxidation (2.86 +/- 0.33 vs. 2.81 +/- 0.35 mg.kg(-1).min(-1)). Because peripheral tissues were exposed to identical glucose, insulin, and free fatty acid levels under the two experimental conditions, we assumed that their glucose uptake and storage were similar during the two tests. We therefore suggest that hepatic glycogen storage (estimated as whole body minus peripheral storage) was also unaffected by the route of glucose delivery. On the other hand, in the i.d. tests, the glucose splanchnic extraction ratio calculated by the dual-isotope technique averaged 4.9 +/- 2.3%, which is close to the figures published for i.v. glucose. Despite the limitations related to whole body measurements, these two sets of data do not support the idea that enteral glucose stimulates hepatic uptake more efficiently than i.v. glucose.
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Affiliation(s)
- F Féry
- Laboratory of Experimental Medicine, Hôpital Erasme, Brussels Free University, B-1070 Brussels, Belgium.
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15
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Rayner CK, Schwartz MP, van Dam PS, Renooij W, de Smet M, Horowitz M, Smout AJPM, Samsom M. Small intestinal glucose absorption and duodenal motility in type 1 diabetes mellitus. Am J Gastroenterol 2002; 97:3123-30. [PMID: 12492199 DOI: 10.1111/j.1572-0241.2002.07109.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Small intestinal glucose absorption is increased in animal models of diabetes mellitus, but little data are available in humans. Small intestinal motility is reported to be frequently abnormal in patients with diabetes and could potentially affect glucose absorption. Our aim was to evaluate small intestinal glucose absorption and duodenal motor responses to intraduodenal nutrients, in patients with type 1 diabetes and controls. METHODS Eight type 1 patients (two with autonomic neuropathy) and nine controls were studied during euglycemia. A manometric catheter was positioned across the pylorus, and nutrient infused intraduodenally (90 kcal over 30 min), followed by a bolus of 3-O-methylglucose (3-OMG). Blood was sampled to measure glucose and 3-OMG concentrations. RESULTS During nutrient infusion, the number of duodenal waves did not differ between patients and controls. After the infusion, patients with diabetes had more propagated duodenal wave sequences (p < 0.05). The area under the plasma 3-OMG curve did not differ between the groups but correlated with both the blood glucose concentration at the time of 3-OMG administration (r = 0.64, p < 0.005) and the number of duodenal waves (r = 0.52, p < 0.05) and antegrade propagated duodenal sequences (r = 0.51, p < 0.05) preceding the 3-OMG bolus. CONCLUSIONS During euglycemia, duodenal motor responses to small intestinal nutrient are comparable in patients with relatively uncomplicated type 1 diabetes and healthy subjects, but duodenal motility after nutrient infusion is increased in patients. Small intestinal glucose absorption is similar in patients and controls, but may be dependent on the blood glucose concentration and duodenal motor activity.
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Affiliation(s)
- C K Rayner
- Gastrointestinal Research Unit, Department of Gastroenterolog University Medical Center, Utrecht, the Netherlands
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Georg P, Kautzky-Willer A, Mahdjoobian K, Hofer A, Prager R, Pacini G, Ludvik BH. Influence of metabolic control on splanchnic glucose uptake, insulin sensitivity, and the time required for glucose absorption in patients with type 1 diabetes. Diabetes Care 2002; 25:2042-7. [PMID: 12401754 DOI: 10.2337/diacare.25.11.2042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The relationship between splanchnic glucose uptake (SGU) after oral glucose administration and metabolic control in type 1 diabetic patients is controversial. We estimated SGU as well as peripheral glucose uptake and the time required for glucose absorption by a validated method, the oral glucose (OG) clamp, in type 1 diabetic patients with different levels of long-term glycemic control. RESEARCH DESIGN AND METHODS An OG clamp (which combines a hyperinsulinemic clamp [120 mU. m(-2). min(-1)] with an OR load [75 g] during steady-state glucose uptake) was performed in eight type 1 diabetic patients with good metabolic control (DG) (HbA(1c) 6.1 +/- 0.2%, BMI 23.1 +/- 0.7 kg/m(2)), eight type 1 diabetic patients with poor metabolic control (DP) (HbA(1c) 8.5 +/- 0.3%, BMI 25.4 +/- 1.4 kg/m(2)), and eight healthy matched control subjects (C) (HbA(1c) 5.1 +/- 0.1%, BMI 25 +/- 1.3 kg/m(2)) to determine SGU, glucose uptake, and glucose absorption. RESULTS Glucose uptake calculated from 120 to 180 min during the clamp was 9.13 +/- 0.55 mg. kg(-1). min(-1) in C, 8.18 +/- 0.71 mg. kg(-1). min(-1) in DG, and 7.42 +/- 0.96 mg. kg(-1). min(-1) in DP (NS). Glucose absorption was 140 +/- 6 min in C, 156 +/- 4 min in DG, and 143 +/- 7 min in DP (NS). The respective calculated SGU was 14.5 +/- 5.6% in C, 17.8 +/- 3.1% in DG, and 18.8 +/- 4.2% in DP (NS) and did not correlate with HbA(1c) values. CONCLUSIONS Peripheral glucose uptake, SGU after oral glucose administration, and the glucose absorption time were not different in type 1 diabetic patients independent of glycemic control when compared with healthy subjects.
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Affiliation(s)
- Petra Georg
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, University of Vienna, Vienna, Austria
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Vella A, Shah P, Basu R, Basu A, Camilleri M, Schwenk WF, Rizza RA. Effect of enteral vs. parenteral glucose delivery on initial splanchnic glucose uptake in nondiabetic humans. Am J Physiol Endocrinol Metab 2002; 283:E259-66. [PMID: 12110530 DOI: 10.1152/ajpendo.00178.2001] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To determine if enteral delivery of glucose influences splanchnic glucose metabolism, 10 subjects were studied when glucose was either infused into the duodenum at a rate of 22 micromol x kg(-1) x min(-1) and supplemental glucose given intravenously or when all glucose was infused intravenously while saline was infused intraduodenally. Hormone secretion was inhibited with somatostatin, and glucose (approximately 8.5 mmol/l) and insulin (approximately 450 pmol/l) were maintained at constant but elevated levels. Intravenously infused [6,6-(2)H(2)]glucose was used to trace the systemic appearance of intraduodenally infused [3-(3)H]glucose, whereas UDP-glucose flux (an index of hepatic glycogen synthesis) was measured using the acetaminophen glucuronide method. Despite differences in the route of glucose delivery, glucose production (3.5 +/- 1.0 vs. 3.3 +/- 1.0 micromol x kg(-1) x min(-1)) and glucose disappearance (78.9 +/- 5.7 vs. 85.0 +/- 7.2 micromol x kg(-1) x min(-1)) were comparable on intraduodenal and intravenous study days. Initial splanchnic glucose extraction (17.5 +/- 4.4 vs. 14.5 +/- 2.9%) and hepatic UDP-glucose flux (9.0 +/- 2.0 vs. 10.3 +/- 1.5 micromol x kg(-1) x min(-1)) also did not differ on the intraduodenal and intravenous study days. These data argue against the existence of an "enteric" factor that directly (i.e., independently of circulating hormone concentrations) enhances splanchnic glucose uptake or hepatic glycogen synthesis in nondiabetic humans.
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Affiliation(s)
- Adrian Vella
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA
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Bischof MG, Bernroider E, Krssak M, Krebs M, Stingl H, Nowotny P, Yu C, Shulman GI, Waldhäusl W, Roden M. Hepatic glycogen metabolism in type 1 diabetes after long-term near normoglycemia. Diabetes 2002; 51:49-54. [PMID: 11756322 DOI: 10.2337/diabetes.51.1.49] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We tested the impact of long-term near normoglycemia (HbA(1c) <7% for >1 year) on glycogen metabolism in seven type 1 diabetic and seven matched nondiabetic subjects after a mixed meal. Glycemic profiles (6.2 +/- 0.10 vs. 5.9 +/- 0.07 mmol/l; P < 0.05) of diabetic patients were approximated to that of nondiabetic subjects by variable insulin infusion. Rates of hepatic glycogen synthesis and breakdown were calculated from the glycogen concentration time curves between 7:30 P.M. and 8:00 A.M. using in vivo (13)C nuclear magnetic resonance spectroscopy. Glucose production was determined with D-[6,6-(2)H(2)]glucose, and the hepatic uridine-diphosphate glucose pool was sampled with acetaminophen. Glycogen synthesis and breakdown as well as glucose production were identical in diabetic and healthy subjects: 7.3 +/- 0.9 vs. 7.1 +/- 0.7, 4.2 +/- 0.5 vs. 3.8 +/- 0.3, and 8.7 +/- 0.5 vs. 8.4 +/- 0.7 micromol x kg(-1) x min(-1), respectively. Although portal vein insulin concentrations were doubled, the flux through the indirect pathway of glycogen synthesis remained higher in type 1 diabetic subjects: approximately 70 vs. approximately 50%; P < 0.05. In conclusion, combined long- and short-term intensified insulin substitution normalizes rates of hepatic glycogen synthesis but not the contribution of gluconeogenesis to glycogen synthesis in type 1 diabetes.
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Affiliation(s)
- Martin G Bischof
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, University of Vienna Medical School, Vienna, Austria
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Nazliel B, Yetkin I, Irkeç C, Koçer B. Current literature in diabetes. Diabetes Metab Res Rev 2001; 17:402-9. [PMID: 11747147 DOI: 10.1002/dmrr.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In order to keep subscribers up-to-date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of diabetes/metabolism. Each bibliography is divided into 17 sections: 1 Books, Reviews & Symposia; 2 General; 3 Genetics; 4 Epidemiology; 5 Immunology; 6 Prediction; 7 Prevention; 8 INTERVENTION: a&rpar General; b&rpar Pharmacology; 9 Pathology: a&rpar General; b&rpar Cardiovascular; c&rpar Neurological; d&rpar Renal; 10 Endocrinology & Metabolism; 11 Nutrition; 12 Animal Studies; 13 Techniques. Within each section, articles are listed in alphabetical order with respect to author (9 Weeks journals - Search completed at 1st Aug 2001)
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Affiliation(s)
- B Nazliel
- Department of Neurology, Gazi University Faculty of Medicine, Ankara, Turkey
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