The effects of starvation, environmental temperature and injury on the rate of disposal of glucose by the rat

Glucose as an adjunct triage tool to the Red Cross Wound Classification

The plasma concentrations of glucose, adrenaline, noradrenaline, insulin, and cortisol were measured in 59 patients within 18 hours of military gunshot/missile (MG/M) wound. The wounds were categorized by the Red Cross Wound Classification (RCWC) and assessed by the Injury Severity Score (ISS) method. The majority of the measured biochemical parameters, except insulin, were significantly increased after MG/M wounds, compared with control values. Plasma glucose concentration in wounded patients was positively related to ISS over the whole severity range. Plasma insulin concentration increased with glucose. Noradrenaline and cortisol were positively related to glucose. Because hemorrhage is the most common cause of general response to MG/M wound, we concluded that glucose measurement could be a useful adjunct tool to the RCWC in rapid and accurate assessment of severely wounded patients, especially those with occult thoraco-abdominal wounds.

Glucose, insulin and other plasma metabolites shortly after injury

A statistical study was made of measurements within 3 h of injury on 533 patients grouped by injury severity using ISS. A scoring system was also used that took account of the number of injuries. Widely accepted hypotheses about the development of hyperglycaemia were not supported. There was evidence of inhibition of glucose metabolism ('insulin resistance'), but none for any particular mechanism. The only factor that was closely related within any group to [glucose] (plasma glucose concentration) was [lactate], the higher mean value and variance of which after very severe injuries (ISS above 15) could account for much of the higher mean and variance of glucose in this ISS range. At ISS 9-14, up to 1.4 h after injury, only 4% of the variance of glucose could be accounted for by any combination of the concentrations of catecholamines, cortisol, lactate and vasopressin, times of measurement after injury and food intake, and injury severity and number of injuries. There was also no dependence on the part of the body injured. Injury increased the variability of [insulin] less than published statements imply. The increase found was entirely explicable, as expected, by the changes of [glucose] and [adrenaline].

Glucose metabolism in children during the first day after burn injury

Plasma and blood metabolites were measured in 31 children over the first day after burn injury. In 14 of them blood glucose peaked, rising within 1-4h to 10-20 mmol/l and then falling, by 4-8 h, to 5-10 mmol/l. Usually the peak value preceded treatment and the fall occurred during infusion of dextrose-saline. Peak incidence was independent of burn severity. There was no evidence of similar peaks in children or adults with other injuries, or in 8 adults with burn injuries; through high glucose levels have been reported in children with head injuries. Lactate, non-esterified fatty acids, insulin, cortisol, epinephrine and norepinephrine were also measured. Values in the first 4 h were similar to those reported in adults with other injuries, except for lactate, which rose less in the children. Unexpectedly, the hyperglycemia in the children with burns was poorly related to epinephrine concentration at all times to 24h. Insulin resistance probably developed within the first hour or two; but from 8 h did not seem to depend on synergism between epinephrine and cortisol.

The metabolic and nutritional effects of injury and sepsis

The existence of a co-ordinated response to stress of a variety of causes has clearly been established. Basically, this consists of an elevation in energy expenditure and an increased breakdown of skeletal muscle protein. In addition, glucose level in the plasma increases as a result of increased synthesis and decreased uptake of glucose into cells. Release of fatty acid into the plasma is also increased, and an elevation in the proportion of energy derived from oxidation of fatty acids is observed. This response is qualitatively very different from that seen in simple starvation, where a progressive reduction in energy expenditure and a reduction in the synthesis of glucose allows fat to become the major energy-producing substrate and also allows sparing of body protein stores. The mechanisms responsible for this altered pattern of metabolism are probably primarily hormonal in nature, with adrenaline, cortisol and glucagon being the major catabolic stimulants. Some evidence exists, however, for alteration in intracellular pathway metabolism. Within the past decade a new class of mediators of the stress response, the cytokines, has been recognized. These substances are protein products of circulating monocytes and the way in which they integrate into the control of the stress response has not been completely elucidated. At present there is evidence that they can stimulate production of catabolic hormones, and also they may well have direct effects in enhancing protein catabolism in muscle. At present the main method for modification of the stress response remains the provision of energy and amino acid, either intravenously or enterally. In the present state of our knowledge, 30-40 kcal kg-1 day-1 would appear to be adequate for most patients, with half provided as fat. Amino acids 3 g kg-1 day-1 will provide adequate nitrogen. It must be said, however, that the most effective method of modifying the stress response is removal of the source of stress by surgery, antibiotics or other primary therapy.

Concentrations of carbohydrates and lipids of guinea pigs after five days starvation

The concentrations of serum total lipids, cholesterol and triglycerides of guinea pigs were determined under normal conditions and after 5 days fasting. Serum glucose and liver glycogen levels were also estimated under both conditions. The amounts of serum total lipids and cholesterol were significantly increased as a result of starvation, whereas, fasting had no significant effect on serum triglycerides. Liver glycogen was rapidly decreased in response to starvation in a highly significant manner. However, starvation did not affect serum glucose of guinea pigs.

Comparison of glycogen store in two strains of rat and guinea-pig under fed and fasted conditions

Glycogen content in the liver, skeletal muscle and heart has been determined in Sprague-Dawley (SD) and Wistar (W) rats and in tricoloured (T) and albino Dunkin Hartley (DH) guinea-pigs. The 12-week-old animals were studied under non-fasted or control conditions (N) and after 48 hr of fast (F48). Hepatic glycogen was higher in DH guinea-pigs (95.6 +/- 3.8 mg g-1) than in W (77.2 +/- 5.3 mg g-1) and SD (80.2 +/- 2.3 mg g-1) rats under N conditions. Mean values for the two strains were slightly higher in guinea-pigs than in rats. After fasting, hepatic glycogen was almost exhausted in the two species but was higher in W (1.5 +/- 0.08 mg g-1) and T (1.5 +/- 0.2 mg g-1) than in SD and DH (0.6 +/- 0.1 mg g-1). The content of glycogen in the anterior muscles of the thigh was comparable in the two strains of rat and guinea-pig, but was twice as high in the guinea-pigs (DH:15.1 +/- 0.6; T: 16.4 +/- 0.7 mg g-1) as in the rats (SD: 8.1 +/- 0.2; W: 7.1 +/- 0.5 mg g-1) under N conditions. In F48 animals, muscular glycogen decreased by 41-46% (rats) and 38-39% (guinea-pigs). Hepatic and extra-liver glycogen stores were calculated and found higher in the guinea-pigs than in the rats. The total utilization during fasting was larger in the guinea-pigs (6140 mg/kg body wt) than in the rats (4500 mg/kg body wt).(ABSTRACT TRUNCATED AT 250 WORDS)

The role of leucine in ketogenesis in starved rats

The quantitative significance of the conversion in vivo of L-[U-14C]leucine to ketone bodies was determined in rats starved for 3 or 48 h. In animals starved for 3 h, 4.4% of ketone-body carbon is derived from the metabolism of leucine, and in rats starved for 48 h the corresponding value is 2.3%. This conversion occurs rapidly, and the specific radioactivity of ketone bodies in blood is maximal at 2 min after the intravenous injection of labelled leucine for both periods of starvation. The flux of leucine in the blood is 1.01 and 1.04 mumol/min per 100 g body wt. respectively for animals starved for 3 and 48 h. The specific radioactivity of blood ketone bodies was compared at 2 min after the injection of labelled leucine, lysine and phenylalanine. The specific radioactivity was 4-5 fold higher with leucine than with lysine or phenylalanine.

The systemic response of the traumatized patient: an overview

A metabolic conflict occurs between increased production of easily used substrates and inhibition of their metabolism in any injured animal. The terms ebb and flow describe the dwindling and rising tides of such activity. The ebb may last 24 to 72 hours; the flow is usually over within two weeks but may last up to eight weeks or longer in more severe cases. The ebb phase corresponds to the traumatic and initial post-traumatic period when there usually is adequate substrate (oxygen, glucose, fatty acid) to meet the diminished demand of the tissues. The flow phase is the period of convalescence. The object of the organism's initial defense following injury seems to stabilize the situation during the ebb phase (preservation of the internal milieu). The longer the ebb phase can be maintained and the more substrates that can be conserved, the more likely the animal will recover during the flow phase. The ebb phase is set in motion by an injury such as hemorrhage, burns, fractures, soft tissue damage by crushing sepsis, or diarrhea. After the ebb phase, a variable, integrated response of nervous, endocrine, and metabolic systems begins, which compromises normal function to achieve specific survival objectives (that is, protection, stabilization and adaptation). Systemic changes (such as tissue catabolism) devoted to caloric needs and local growth (that is, wound repair) are all directed at the ultimate objective of survival.

In vivo glucose turnover in hypo- and hyperthyroid starved rat

The effect of hypo- and hyperthyroidism on glucose turnover in vivo was determined in unanesthetized rats starved for 48 h. Glucose pool and decay rate of specific radioactivity of blood glucose was measured after bolus injection of a mixture of 3H-(2)- and 14C-(U)-glucose under steady state conditions. Compared with euthyroid controls (= 100%), hypothyroidism resulted in a decrease of blood glucose concentration (81%), glucose pool (52%), glucose disappearance rate (39%), and total glucose recycling (12%). In contrast, hyperthyroidism led to an increase of blood glucose concentration (148%), glucose pool (121%), glucose disappearance rate (185%), and total glucose recycling (163%). T 1/2 for glucose was calculated to be 46 min in the hypo-, 34 min in the eu-, and 22 min in the hyperthyroid state. The concentration of circulating glucoregulatory hormones, corticosterone and glucagon were elevated in hyperthyroid rats, while glucagon was diminished in hypothyroid animals. No difference in the level of insulin was found. These data demonstrate that glucose turnover in vivo is a function of the thyroid state being reduced in hypo- and considerably increased in hyperthyroidism.

Studies on the mechanism of insulin resistance after injury in the mouse

Acute insulin resistance developed after scald injury in the mouse. After 2h plasma glucose and insulin concentrations were each raised about two-fold. Glucose metabolism was studied in vitro in soleus muscles isolated at this time. Glycolysis and glycogen synthesis, and their stimulation by insulin, were unchanged in muscles from scalded mice, and insulin-stimulated transport of 2-deoxyglucose slightly increased, showing that the insulin resistance seen in vivo is not maintained in isolated tissues. Binding of insulin to liver cell membranes prepared from scalded mice was unaltered, whilst that of glucagon was slightly but significantly reduced, showing that changes in polypeptide-hormone receptors can occur within this short time. It was concluded that the acute loss of sensitivity to insulin after injury does not result from a change in insulin receptor sites and presumably reflects an impairment of glucose metabolism in vivo mediated by circulating hormones.

The effects of hypoglycin on glucose metabolism in the rat. A kinetic study in vivo and [U-14C,2-3H]glucose

1. The kinetics of glucose metabolism were evaluated in rats deprived of food 15-21 h after the administration of hypoglycaemic doses of hypoglycin (100 mg/kg body wt.) by following changes in the specific radioactivities of 14C and 3H in blood glucose after an intravenous dose of [U-14C,2-3H]glucose [Katz, Rostami & Dunn (1974) Biochem. J. 142, 161-170]. 2. During this time, recycling of glucose through the Cori cycle was virtually abolished, the rate of irreversible disposal of glucose and its total body mass were both decreased by about 70%, whereas there was little effect on the mean transit time for glucose. 3. It was concluded that hypoglycaemia is due to inhibition of gluconeogenesis.

Rates of glucose utilization and glucogenesis in rats in the basal state induced by halothane anaesthesia

1. Rates and rate coefficients of glucose utilization and replacement were determined with [5-3H]- and [U-14C]-glucose in rats starved for 24h, either conscious or under halothane anaesthesia, in a thermoneutral environment. Plasma insulin concentrations were also measured. 2. Halothane anaesthesia decreased the turnover rate by 20%, which was similar to previously reported decreases in metabolic rates caused by natural sleep. 3. Fractional recycling of glucose carbon was little affected by halothane. 4. Comparison of values in one rat with those in another, among both conscious rats and those under halothane anaesthesia, showed that rate coefficients were inversely correlated with plasma glucose concentrations. 5. These findings indicated that halothane, in the concentration used (1.25%, v/v), had little specific effect on glucose metabolism. 6. Although equilibrium plasma glucose concentrations in different rats under halothane were widely different (4-8 mmol/l) the rates of utilization were very similar (2.5-3.1 micronmol/min per 100 g), indicating that these rates were determined by the production of glucose from gluconeogenic precursors released by basal metabolism, the rate of which is necessarily similar in different rats. 7. Among rats under halothane anaesthesia plasma insulin concentrations were negatively correlated with rate coefficients, showing that the differences between rate coefficients were mostly accounted for by differences between rats in tissue sensitivities to insulin. Thus in each 24h-starved rat, sleeping or resting, the main regulators of the plasma glucose concentrations were the rate of supply of gluconeogenic substrates from energy metabolism and the intrinsic sensitivity of the tissues to insulin. 8. We found that a commonly used deionization method of purifying glucose for determination of its specific radioactivity was inadequate.

Glucose turnover in the post-absorptive rat and the effects of halothane anaesthesia

1. Rates and rate coefficients of glucose utilization and replacement in post-absorptive rats, either conscious or under halothane anaesthesia, were determined in a thermoneutral environment by using [5-3H]- and [U-14C]glucose. Label was not injected into rats under halothane until about 0.5h after anaesthesia was initiated. 2. Comparison with the results for 24h-starved rats in the preceding paper [Heath et al. (1977) Biochem. J. 162, 643-651] showed that insulin concentrations were considerably higher but rate coefficients for glucose utilization were little altered in post-absorptive rats. Sensitivity to insulin was thus considerably increased by a 24h period of starvation in the rat. 3. Fractional recycling of glucose carbon in post-absorptive rats was under one-half of that in starved rats, reflecting the larger contribution of liver glycogenolysis to glucose production in the former. 4. In post-absorptive rats halothane decreased the mean rate of glucose utilization by about 17%. This decrease was associated with an increase in mean plasma insulin concentration, showing that halothane decreased sensitivity to insulin. 5. Recycling was slightly increased by halothane, indicating that the contribution of liver glycogen to the total glucogenic rate was decreased, probably because liver glycogen concentration were about 40% lower throughout the rate determinations in halothane. 6. Comparison of our results with earlier work shows that during and shortly after induction of halothane anaesthesia glucose turnover must have been greatly increased whereas from about 0.5h after induction it was decreased.

Reversible and irreversible glucose disposal in dogs: influence of fasting and cold exposure

Rates of total glucose entry rate, irreversible loss, and recycling were measured in unanesthetized dogs with indwelling arterial and venous catheters. Four experimental conditions were selected: 16 or 26 hr of fasting and neutral (+25 degrees C) or cold (-21 degrees C) ambient temperatures. A mixture of U 14C-glucose and 2-3H-glucose was used as a tracer, according to the primed infusion technique. No matter what the ambient temperature was, increase of fasting time from 16 to 26 hr induced a slight, but nonsignificant, decrease in both the total glucose entry rate and the irreversible loss. At neutral ambient temperature, the amount of glucose promptly recycled was less after 16 hr than after 26 hr of fasting, while an opposite pattern was observed during cold exposure. Thus, that part of hepatic glucose entry promptly recycled was significantly increased from 22% (16 hr of fasting) to 31% (26 hr of fasting) at neutral ambient temperature. It remained almost unchanged (20% and 18%) in cold. It was, therefore, suggested that this increase might be considered as an compensatory mechanism, exerting a sparing effect on glucose utilization. This mechanism does not occur in cold ambient temperature, thus, worsening a possible shortage in glucose supply.

Insulin secretion after injuries of differing severity in the rat

The effects on insulin secretion of injuries of differing severity have been studied in the rat. The injuries used were dorsal scalds to 20% and 40% of the body surface area, and a 4-h period of bilateral hind-limb ischaemia. These injuries resulted in 48 h mortality rates of 0/10, 7/10 and 5/10 respectively. Rats were studied 1-5-2 h after scalding or removal of tourniquets. The blood glucose concentration was markedly raised after all these injuries, and the plasma insulin concentration was also raised, so that the insulin to glucose ratio in any group did not differ significantly from that in non-injured controls. Injection of glucose (0-5 g/kg i.v.) induced a rise in insulin concentration in all groups, although the insulin to glucose ratio after the lethal 40% scald was lower than in control rats. It was concluded that in the rat normal insulin secretion is maintained even after lethal injuries, although some suppression of the insulin response to exogenous glucose may occur. Insulin resistance is more important in the rat than impairment of insulin secretion even at an early stage after injury.

Effect of ischaemic limb injury on the rates of metabolism of ketone bodies in starved rats

1. Rats starved for 30h were injected with trace amounts of [3-14C]acetoacetate and beta-hydroxy[3-14C]butyrate 1h after ischaemic limb injury in a 20 degrees C environment, and the concentrations and radioactivities of blood ketone bodies were determined at intervals. 2. Starvation alone raised the rates of production and utilization of beta-hydroxybutyrate plus acetoacetate about 3.7-fold, but lowered their metabolic clearance rates by about 50%. In the starved rat ketone-body oxidation could account for up to 30% of whole body O2 consumption. 3. Injury in starved rats lowered the rates of production and utilization of both beta-hydroxybutyrate and acetoacetate, the combined fall of about 37% slightly exceeding the concomitant fall in whole-body O2 consumption. The concentration of beta-hydroxybutyrate decreased after injury, but its metabolic clearance rate was unaltered; the concentration of acetoacetate rose slightly and its metabolic clearance rate fell.

Effects of metformin on insulin resistance after injury in the rat

Hyperglycaemia and insulin resistance occur after injury. The effects of the antidiabetic biguanide metformin in injured rats have been studied in order to elucidate the cause of these effects. Metformin (120 mg/kg S. C.) produced a significant hypoglycaemic effect after a 20% dorsal scald but did not affect the blood glucose concentration in non-injured rats. The hypoglycaemic effect did not result from increased insulin secretion. It was associated with a reduction in liver glycogen and an increase in blood lactate concentrations, suggesting that the drug acted by promoting peripheral glucose utilization. This was confirmed by measuring the clearance rate coefficient of [5-3H]glucose. This rate coefficient was significantly increased by metformin treatment (140 mg/kg S. C.) in scalded rats, although it was not affected in non-injured rats. Intravenous glucose tolerance in scalded rats was not improved, probably because of the increased lactate concentration. Metformin (120-160 mg/kg) also produced a hypoglycaemic effect in rats after a 4 hrs period of bilateral hind-limb ischaemia, suggesting that similar metabolic changes occur after these two types of injury.

Lactate-glucose interrelations, glucose recycling and the Cori cycle in normal fed rats

1. Turnover and oxidation rates of glucose and lactate were determined using a priming dose-continuous infusion of 14C-(u)-glucose and 14C-(U)-lactate in anesthetized and mechanically ventilated non-fasted rats. The rates of glucose-lactate interconversions were computed from the two-compartment model of Depocas and De Freitas (1970). The rate of total glucose recycling is known as the difference between the rate of true glucose turnover measured with 3H-(2)-glucose (RGT) and the rate of apparent glucose turnover measured with 14C-glucose (RG). This value was compared with the Cori cycle. 2. In normal conditions 17% of RG come from lactate, 43% are directed to lactate and 49% are oxidized. 3. 71% of the rate of lactate turnover come from glucose, 28% are directed to glucose and 51% are oxidized. 4. The rate of total glucose recycling (RGT-RG) is 3.7 mg - mn(-1) per kg0.75 and represents 60% of RG or 38% of RGT. 5. The Cori cycle is 0.8 - 1.2 mg - mn(-1) per kg0.75 and represents 8 - 20% of the rate of glucose turnover and 20 - 32% of total glucose recycling.

Effects of burn injury on insulin secretion and on sensitivity to insulin in the rat in vivo

Both insulin resistance and impairment of insulin secretion are know to occur in man after injury. The relative importance of these effects was studied in rats 2 h after a non-lethal 20 percent dorsal scald. No impairment of insulin secretion was found after this injury. Concentrations of both blood glucose and plasma insulin were elevated in scalded rats. Scalded rats responded to intravenous glucose injection (1-0 g/kg) with a further rise in plasma insulin concentration, which remained normal for the prevailing blood glucose concentration. However, marked impairment of glucose tolerance was observed, indicating the presence of insulin resistance. After intravenous insulin injection (1-0 U/kg) the initial rate coefficient for fall of blood glucose concentration was significantly lower (p less than 0-02) in scalded (mean 3-9 percent min.(-1) than in control rats (mean 6-3 percent min.(-1). The minimum in blood glucose concentration after insulin injection was reached at 10 min. in control rats, but not until 60 min. after injection in scalded rats. This difference was due to a delay in compensation for the hypoglycaemia in the scalded rats, since the rate of disappearance of insulin measured by injection of a tracer of 125I-labelled bovine insulin was not decreased after this injury. It was concluded that the impairment of glucose utilization in scalded rats (Heath and Corney, 1973) is due to decreased sensitivity to insulin rather than to suppression of insulin release.

The design of experiments using isotopes for the determination of the rates of disposal of blood-borne substrates in vivo with special reference to glucose, ketone bodies, free fatty acids and proteins

1. The two well-known methods of estimating rates of irreversible disposal (R) of blood-borne substrates in vivo by isotope experiments involve estimating the specific radioactivity (S) of the substrate in blood either after single intravenous injection of labelled substrate or during its infusion at a constant rate. The value of R is calculated from the S-time curve, usually by assuming: (i) a metabolic steady state with respect to substrate, (ii) the passage of all substrate through the blood, and (iii) the absence of certain types of recycling via blood. 2. In a theoretical investigation we show how experiments can be performed and R calculated from analyses of blood when one or more of the above assumptions is unjustified, by using glucose, ketone bodies, plasma free fatty acids and proteins as examples. In general the methods require single injection procedures, with estimation of the total quantity of label in the substrate in blood and the substrate concentration instead of only S. Such values give estimates of R with standard errors even when only one blood specimen is taken from each of a group of animals, as is convenient when working with small animals or substrates in low concentration, and when the animals are in a non-steady state in which constant infusion procedures are invalid. 3. Similar methods give the fraction of label injected as one compound which passes through another (the isotopic yield). 4. The methods are not always applicable, and cannot be applied to plasma proteins in some pathological conditions. A questionnaire for assessing their applicability is given.

The interconversion and disposal of ketone bodies in untreated and injured post-absorptive rats

[3-(14)C]Acetoacetate and beta-hydroxy[3-(14)C]butyrate were used to investigate the kinetics of ketone body metabolism in rats 3h after bilateral hind-limb ischaemia and in controls, both groups being in the post-absorptive state and in a 20 degrees C environment. Calculations were carried out as described by Heath & Barton (1973) and the following conclusions were reached. 1. In both injured and control rats, the rates of irreversible disposal (extrahepatic utilization) of beta-hydroxybutyrate and acetoacetate were proportional within experimental error to their blood concentrations up to at least 0.4mm (the maximum found in these rats), implying that they were determined, via these concentrations, by the rates of production by the liver. 2. Conversion of blood beta-hydroxybutyrate into blood acetoacetate took place mainly in the liver, but the reverse process occurred mainly in extrahepatic tissues. 3. The ;metabolic clearance rate' (the volume of blood which, if completely cleared of substrate in unit time, would give a disposal rate equal to that in the whole animal) was calculated for beta-hydroxybutyrate and acetoacetate. Comparison with the cardiac output showed that in control rats the proportion of circulating beta-hydroxybutyrate extracted was lower than that of acetoacetate, clearance of which appeared almost complete. After injury both metabolic clearance rates decreased, probably because of the lower cardiac output. 4. After injury, because the average blood concentrations of ketone bodies, especially acetoacetate, were higher, the mean total rate of disposal also increased. Assuming complete oxidation, the mean contribution of ketone bodies to the whole body O(2) consumption rose from 7 to 15%.