Factors governing insulin and glucagon responses during normal meals

Comparison of the Acute Postprandial Circulating B-Vitamin and Vitamer Responses to Single Breakfast Meals in Young and Older Individuals: Preliminary Secondary Outcomes of a Randomized Controlled Trial

B-vitamin deficiency is common in ageing populations either due to altered dietary habits or altered digestive and metabolic functions. There is limited data on the acute circulating concentrations of B-vitamins and their various forms (vitamers), following ingestion of realistic meals. This study compared the acute circulating B-vitamin and vitamer responses to either an energy-dense (ED) or a nutrient-dense (ND) breakfast meal, consumed in a randomized cross-over sequence, in older and younger adults (n = 15 and 15, aged 67.3 ± 1.5 and 22.7 ± 0.5 years (mean ± SEM), respectively). Eleven differing B-vitamins and vitamers were determined in plasma samples by ultra-high-performance liquid chromatography-tandem mass spectrometry, in the fasting and postprandial state (hourly for 5 h). While postprandial thiamine concentration increased following both meals, riboflavin increased only following a ND meal in both age groups. Many vitamins including nicotinic acid, pantothenic acid, pyridoxal, pyridoxamine, pyridoxal-5'phosphate, and 4-pyridoxic acid remained unaltered, and flavin mononucleotide (FMN), nicotinamide and nicotinuric acid concentrations reduced following both meals. Biological age and food composition had minimal impact on postprandial B-vitamin concentrations, yet the differences between the ED and ND meals for riboflavin highlight the importance of riboflavin intake to achieve adequacy.

Physiological and therapeutic regulation of glucose homeostasis by upper small intestinal PepT1-mediated protein sensing

High protein feeding improves glucose homeostasis in rodents and humans with diabetes, but the mechanisms that underlie this improvement remain elusive. Here we show that acute administration of casein hydrolysate directly into the upper small intestine increases glucose tolerance and inhibits glucose production in rats, independently of changes in plasma amino acids, insulin levels, and food intake. Inhibition of upper small intestinal peptide transporter 1 (PepT1), the primary oligopeptide transporter in the small intestine, reverses the preabsorptive ability of upper small intestinal casein infusion to increase glucose tolerance and suppress glucose production. The glucoregulatory role of PepT1 in the upper small intestine of healthy rats is further demonstrated by glucose homeostasis disruption following high protein feeding when PepT1 is inhibited. PepT1-mediated protein-sensing mechanisms also improve glucose homeostasis in models of early-onset insulin resistance and obesity. We demonstrate that preabsorptive upper small intestinal protein-sensing mechanisms mediated by PepT1 have beneficial effects on whole-body glucose homeostasis.

High protein diets are known to improve metabolic parameters including adiposity and glucose homeostasis. Here the authors demonstrate that preabsorptive upper small intestinal protein-sensing mechanisms mediated by peptide transporter 1 improve glucose homeostasis by inhibiting hepatic glucose production.

Glucagon action in the brain

In recent years, novel discoveries have reshaped our understanding of the biology of brain glucagon in the regulation of peripheral homeostasis. Here we compare and contrast brain glucagon action in feeding vs glucose regulation and depict the physiological relevance of brain glucagon by reviewing their actions in two key regions of the central nervous system: the mediobasal hypothalamus and the dorsal vagal complex. These novel findings pave the way to future therapeutic strategies aimed at enhancing brain glucagon action for the treatment of diabetes and obesity. This review summarises a presentation given at the 'Novel data on glucagon' symposium at the 2015 annual meeting of the EASD. It is accompanied by two other reviews on topics from this symposium (by Young Lee and colleagues, DOI: 10.1007/s00125-016-3965-9 ), and by Russell Miller and Morris Birnbaum, DOI: 10.1007/s00125-016-3955-y ) and an overview by the Session Chair, Isabel Valverde (DOI: 10.1007/s00125-016-3946-z ).

Glucagon signalling in the dorsal vagal complex is sufficient and necessary for high-protein feeding to regulate glucose homeostasis in vivo

High-protein feeding acutely lowers postprandial glucose concentration compared to low-protein feeding, despite a dichotomous rise of circulating glucagon levels. The physiological role of this glucagon rise has been largely overlooked. We here first report that glucagon signalling in the dorsal vagal complex (DVC) of the brain is sufficient to lower glucose production by activating a Gcgr-PKA-ERK-KATP channel signalling cascade in the DVC of rats in vivo. We further demonstrate that direct blockade of DVC Gcgr signalling negates the acute ability of high- vs. low-protein feeding to reduce plasma glucose concentration, indicating that the elevated circulating glucagon during high-protein feeding acts in the brain to lower plasma glucose levels. These data revise the physiological role of glucagon and argue that brain glucagon signalling contributes to glucose homeostasis during dietary protein intake.

Different glycemic indexes of breakfast cereals are not due to glucose entry into blood but to glucose removal by tissue

BACKGROUND

The glycemic index (GI) of a food is thought to directly reflect the rate of digestion and entry of glucose into the systemic circulation. The blood glucose concentration, however, represents a balance of both the entry and the removal of glucose into and from the blood, respectively. Such direct quantification of the postprandial glucose curve with respect to interpreting the GI is lacking in the literature.

OBJECTIVE

We compared the plasma glucose kinetics of low- and high-GI breakfast cereals.

DESIGN

On 2 occasions, plasma insulin concentrations and plasma glucose kinetics (by constant-rate infusion of [6,6-(2)H(2)]glucose) were measured in 6 healthy males for 180 min after they fasted overnight and then consumed an amount of corn flakes (CF) or bran cereal (BC) containing 50 g available carbohydrate.

RESULTS

The GI of CF was more than twice that of BC (131.5 +/- 33.0 compared with 54.5 +/- 7.2; P < 0.05), despite no significant differences in the rate of appearance of glucose into the plasma during the 180-min period. Postprandial hyperinsulinemia occurred earlier with BC than with CF, resulting in a 76% higher plasma insulin concentration at 20 min (20.4 +/- 4.5 compared with 11.6 +/- 2.1 micro U/mL; P < 0.05). This was associated with a 31% higher rate of disappearance of glucose with BC than with CF during the 30-60-min period (28.7 +/- 3.1 compared with 21.9 +/- 3.1 micro mol. kg(-)(1). min(-)(1); P < 0.05).

CONCLUSION

The lower GI of BC than of CF was not due to a lower rate of appearance of glucose but instead to an earlier postprandial hyperinsulinemia and an earlier increase in the rate of disappearance of glucose, which attenuated the increase in the plasma glucose concentration.

Effect of a high-protein, energy-restricted diet on body composition, glycemic control, and lipid concentrations in overweight and obese hyperinsulinemic men and women

BACKGROUND

It is not clear whether varying the protein-to-carbohydrate ratio of weight-loss diets benefits body composition or metabolism.

OBJECTIVE

The objective was to compare the effects of 2 weight-loss diets differing in protein-to-carbohydrate ratio on body composition, glucose and lipid metabolism, and markers of bone turnover.

DESIGN

A parallel design included either a high-protein diet of meat, poultry, and dairy foods (HP diet: 27% of energy as protein, 44% as carbohydrate, and 29% as fat) or a standard-protein diet low in those foods (SP diet: 16% of energy as protein, 57% as carbohydrate, and 27% as fat) during 12 wk of energy restriction (6-6.3 MJ/d) and 4 wk of energy balance ( approximately 8.2 MJ/d). Fifty-seven overweight volunteers with fasting insulin concentrations > 12 mU/L completed the study.

RESULTS

Weight loss (7.9 +/- 0.5 kg) and total fat loss (6.9 +/- 0.4 kg) did not differ between diet groups. In women, total lean mass was significantly (P = 0.02) better preserved with the HP diet (-0.1 +/- 0.3 kg) than with the SP diet (-1.5 +/- 0.3 kg). Those fed the HP diet had significantly (P < 0.03) less glycemic response at weeks 0 and 16 than did those fed the SP diet. After weight loss, the glycemic response decreased significantly (P < 0.05) more in the HP diet group. The reduction in serum triacylglycerol concentrations was significantly (P < 0.05) greater in the HP diet group (23%) than in the SP diet group (10%). Markers of bone turnover, calcium excretion, and systolic blood pressure were unchanged.

CONCLUSION

Replacing carbohydrate with protein from meat, poultry, and dairy foods has beneficial metabolic effects and no adverse effects on markers of bone turnover or calcium excretion.

Plasma glucagon and insulin responses depend on the rate of appearance of amino acids after ingestion of different protein solutions in humans

To find out whether the hormonal response to feeding with protein solutions is influenced by the nature and degree of protein fractionation, we examined insulin and glucagon responses after intake of protein solutions containing the same amount of nitrogen (2.9 g each) in three men and three women. Four test meals (600 mL) [glucose (419 kJ/L), pea (PPH) and whey peptide hydrolysates (WPH) (921 and 963 kJ/L, respectively) and a cow's milk solution (MS) containing complete milk proteins (2763 kJ/L)] were tested. Peptide hydrolysates elicited a faster increase in venous plasma amino acids than did MS (P < 0.05). Despite the higher carbohydrate content of the MS, the peptide hydrolysates elicited a peak insulin response that was two and four times greater than that evoked by the MS and glucose solutions, respectively (P < 0.05). The insulin response was closely related to the increase in plasma amino acids, especially leucine, isoleucine, valine, phenylalanine and arginine, regardless of the rate of gastric emptying. The three protein solutions elicited similar increases of plasma glucagon; however, the response was fastest for both peptide hydrolysates (P < 0.05) and more prolonged for the MS (P < 0.05). The glucagon response was linearly related to the increase in plasma amino acids, regardless of the rate of gastric emptying or meal composition (r = 0.93, r = 0.96 and r = 0.78, all P < 0.05, for the PPH, WPH and MS). Among the plasma amino acids, tyrosine (r = 0.82-0.98, P < 0.05) and methionine (r = 0.98, P < 0.001) were most closely related to the plasma glucagon response. This study shows that the glucagon response to feeding with protein solutions depends on the increase in plasma amino acid concentrations. The combined administration of glucose and peptide hydrolysates stimulates a synergistic release of insulin, regardless of the protein source.

Effect of orosensory stimulation on postprandial thermogenesis in humans

This study assessed the effects of orosensory stimulation by equipalatable stimuli that differed in macronutrient content (lipid and carbohydrate) on postprandial thermogenesis. Sixteen healthy, normal-weight adults (eight males, eight females) participated in six test sessions conducted weekly. The test sessions were administered randomly after overnight fasts and included: ingestion of 50 g of butter in capsules (to avoid oral stimulation with lipids) and 500 ml of water in 15 min followed by no oral stimulation or oral stimulation with a cracker or one of the following foods on a cracker-butter, unsaturated fatty acid (UFA) margarine, jelly, UFA margarine+jelly. Sensory stimulation entailed masticating and expectorating approximately 5.0 g samples of each stimulus every 3 min for 110 min. Blood was drawn immediately after preload ingestion and at minutes 35, 85, 200, 320, and 440 postloading and was analyzed for insulin, glucagon, and glucose. No significant treatment differences were observed for thermogenesis or oxidation of carbohydrate or lipid. Insulin, glucagon, and glucose concentrations were not different between treatments. These data suggest that orosensory stimulation with stimuli differing in lipid and carbohydrate content, but rated similarly in palatability, does not elicit an increased or differential diet-induced thermogenic response.

Role of the liver in the metabolic control of eating: what we know--and what we do not know

Profound metal-related changes in the supply of metabolites to t he liver and in the hepatic metabolism occur, and there is ample evidence that neural signals from hepatic metabolic sensors can affect eating. Hepatic afferent nerves presumably represent glucosensors which contribute to the control of eating by monitoring their own glucose utilization. Yet, the nature of the putative sensors that respond to the oxidation of other metabolites than glucose had not been identified. ATP and sodium pump activity may link hepatic oxidative metabolism and membrane potential, because hepatic phosphate-trapping by 2,5-anhydro-mannitol, and inhibition of sodium pump activity by ouabain is associated with a stimulation of eating. Hepatocyte membrane potential is also subject to changes in transmembranal potassium flow through volumetrically controlled membranal potassium channels. Yet it is unknown if and how hepatocytes are linked to afferent nerves. It is also unclear how the effects of glucagon and insulin fit into the hepatic metabolic control of eating. Glucagon appears to induce satiety through its actions in the liver, but the involved mechanism is still unclear. Recent studies suggest that insulin, which has mainly been explored as a centrally acting long-term satiety signal, has an immediate effect on meal size, but is presently unknown whether an hepatic action of insulin is involved.

Glucose and insulin responses after commonly used sport feedings before and after a 1-hr training session

This investigation examined the plasma glucose and insulin response in 6 trained athletes after consumption of four commercially available sport feedings 2 hr before as well as immediately after 1 hr of running under common training conditions. Four feedings were compared: Feeding 1, 160 g CHO/400 ml; Feeding 2, 69 g CHO/400 ml; Feeding 3, 69 g CHO + 6 g protein/400 ml; and Feeding 4, solid 69 g CHO + 5 g protein + 4 g fat. Before the training session, there were no differences between the four sport feedings in the area under the glucose and insulin curves and the insulin/glucose ratio. However, after exercise, Feeding 2 resulted in a significantly greater area under the glucose curve compared with Feedings 1, 3, and 4 (respectively, 352 vs. 241, 251, and 182) and a significantly lower insulin/glucose ratio compared with Feeding 1 (respectively, 6.2 vs. 15.8). Therefore, it is concluded that the kind of sport feeding may influence postexercise glucose and insulin responses.

Cephalic-phase insulin in obese and normal-weight men: relation to postprandial insulin

Cephalic-phase insulin release (CPIR) and its relation to postprandial insulin release were examined in 18 normal-weight and 15 obese men. When the insulin data were expressed as absolute differences from baseline values, obese subjects exhibited significantly greater CPIR than normal-weight subjects (normals, 8.7 +/- 2.1 microU/mL/10 min; obese, 13.4 +/- 4.3 microU/mL/10 min; P < .01). Obese subjects were then separated into groups depending on their fasting insulin levels. This showed that only those subjects with elevated fasting insulin levels exhibited greater CPIR than normal subjects, and suggested that previous reports of exaggerated CPIR in the obese are merely a reflection of a basal hypersecretion of insulin. However, when insulin values were expressed as percentages of baseline, no significant differences between normal-weight and obese subjects were found, although a trend toward an attenuated response was observed in the obese group as a whole (normals, 81.6 +/- 19.1 microU/mL/10 min; obese, 51.3 +/- 16.1 microU/mL/10 min). A significant correlation between cephalic-phase and postprandial insulin release was found in normal-weight subjects (r = .62, P < .05), but not in obese subjects (r = .02, P < .9).

Cephalic phase insulin release in bulimia

Cephalic phase secretions are associated with the sight, smell, and taste of food, as opposed to its postingestional consequences. These secretions are thought to influence metabolism and eating behavior. Cephalic phase insulin release (CPIR), in particular, might be related to hunger and overeating. It was hypothesized that bulimics, who often show endocrine abnormalities, may have an altered CPIR that, in turn, might be related to the precipitation and maintenance of binges. This study investigated whether (1) the profile or magnitude of the CPIR in bulimics differs from that of non-eating disordered controls, (2) food ingestion alters subsequent CPIR, and (3) mood and desire to binge are related to CPIR. Findings indicated little abnormality in bulimics' profile of insulin secretion. Although biological variables were not related to hunger or desire to binge, for bulimics, dysphoric moods were. The results may suggest more complex determinants of binge eating than physiological state alone.

Postprandial glucose and insulin responses to various tropical fruits of equivalent carbohydrate content in non-insulin-dependent diabetes mellitus

The plasma glucose and insulin responses were determined in 10 NIDDM female patients following the ingestion of tropical fruit containing 25 g of carbohydrate. The five tropical fruits were pineapple, mango, banana, durian and rambutan. Blood was drawn at 0, 30, 60, 120 and 180 min, respectively. The results showed that the glucose-response curves to mango and banana were significantly less than those to rambutan, durian and pineapple (P less than 0.05). Only the glucose area after mango ingestion was significantly less than the glucose areas of the other fruits (P less than 0.05). The insulin response curve and insulin area after durian ingestion was statistically greater than after ingestion of the others. We concluded that after mango ingestion, the glucose area was lower than it had been after rambutan, durian and pineapple ingestion and the insulin area was lower than that after durian ingestion of equivalent carbohydrate content in type 2 (NIDDM) diabetes.

Cephalic phase insulin release in normal weight males: verification and reliability

The existence and reliability of cephalic phase insulin release (CPIR) were tested in 20 normal weight males. Each subject was challenged three times with the same food stimulus over a 5-day period. Four baseline blood samples were taken at 5-min intervals before food ingestion and then every 2 min for 16 min postingestion. Significant increases in plasma insulin were found at 4 min postingestion on each trial day. CPIR was found to be highly reproducible between trials (r = 0.83; P less than 0.001). Fifty percent of the subjects exhibited a significant increase of plasma insulin above their own baseline mean on the first trial, whereas 75 and 72% exhibited increases on trials 2 and 3, respectively. Only two subjects (10%) did not demonstrate a response on any trial. A significant decline in plasma glucose was observed at 4 min postingestion on trials 2 and 3. No significant changes in plasma glucagon were found during any trial day. This study confirms a reliable CPIR in normal weight males.

Dose-kinetics of pancreatic alpha- and beta-cell responses to a protein meal in normal subjects

A protein meal is well known to induce a prompt secretion of insulin and glucagon. However, the data regarding the dose-response relationship between the protein meal and the insulin and glucagon responses are sparse. This study assessed the effects of ingestion of protein meals of varying amounts on plasma glucose [S], insulin [I], and glucagon [G] concentrations in eight normal subjects. Protein meals were administered after an overnight fast in a randomized sequence at intervals of 10 days in four different quantities: 250 mg/kg body weight (BW) (A), 500 mg/kg BW (B), 1 g/kg BW (C), and 2 g/kg BW (D). Mean S levels were not significantly altered following A, B, or C, although significant decreases in S responses were noted after C and D as reflected by absolute changes (delta) and/or the cumulative responses (CR) and the areas under the curve (sigma). Mean I increased promptly to peak concentration by 30 minutes, although in individual subjects the peak was achieved either at 30 or 60 minutes following all protein meals. The increase was progressively greater and the return was delayed with increasing quantities resulting in progressive elevations in delta I and percent increase from basal concentration (%), as well as CRI and sigma I. G increased following all protein meals as well. The mean peak G concentrations were achieved by 90 minutes, although in individual subjects the peak G was reached at 90 or 120 minutes, a significant delay in comparison to the peak I levels. G returned to base line only following ingestion of A during the study period.(ABSTRACT TRUNCATED AT 250 WORDS)

Pancreatic glucagon signals postprandial satiety

The hypothesis that prandial increases in circulating pancreatic glucagon initiates an important peripheral satiety signal is reviewed. Glucagon administration at the beginning of meals reduces the size of test meals in animals and humans and reduces the size of spontaneous meals in rats. Exogenous glucagon may also interact synergistically with cholecystokinin to inhibit feeding. These appear to be satiety effects because they are behaviorally specific in rats and subjectively specific in humans. Glucagon's pharmacological satiety effect is complemented by compelling evidence for a necessary contribution of endogenous glucagon to the control of meal size: administration of glucagon antibodies increases both test and spontaneous meal size in rats. Under many, but not all, conditions exogenous glucagon's satiety effect appears to originate in the liver and to be relayed to the brain via hepatic vagal afferents. Analysis of the central processing of this signal, however, has barely begun. How glucagon changes are transduced into neural afferent signals also remains an open question. The only hypothesis that has been extensively tested is that stimulation of hepatic glucose production initiates the satiety signal, but this is neither convincingly supported nor clearly rejected by currently available data. It is also not yet clear whether glucagon contributes to some forms of obesity or has potential use as a therapeutic tool in the control of eating disorders. Of the several proposed controls of hunger and satiety, glucagon appears to be one of the most likely to be physiologically relevant. This encourages further analysis of its behavioral characteristics, its neural mechanisms, and its clinical potential.

Decreased feeding and supraphysiological plasma levels of glucagon after glucagon injection in rats

The effects of intraperitoneally injected pancreatic glucagon on feeding and on plasma levels of pancreatic glucagon as well as on blood glucose levels and liver glycogen content were investigated in rats, in order to test the physiological relevance of exogenous glucagon's satiety effect. The rats were intraperitoneally injected with various doses of glucagon [60, 240 or 480 micrograms/kg body weight (b.wt.)] or vehicle when they started to eat after a 12 hr period of food deprivation. Only the highest dose of pancreatic glucagon (480 micrograms/kg b.wt.) decreased the size and duration of the first meal after injection. Hepatic vein, hepatic portal vein and aortal plasma pancreatic glucagon levels were increased about 10 fold by 60 and 240 micrograms/kg b.wt. of glucagon and about 30 to 70 fold by 480 micrograms/kg b.wt. of glucagon. All glucagon doses reduced liver glycogen content and increased hepatic vein blood glucose levels similarly. The results indicate that decreased feeding after intraperitoneal injection of glucagon is a pharmacological effect of the hormone, at least under the conditions tested.

Pancreatic glucagon's effects on satiety and hepatic glucose production are independently affected by diet composition

We tested whether pancreatic glucagon's effects on satiety and hepatic glycogenolysis depend on variations in the macronutrient composition of the diet. Rats were kept on high carbohydrate, high fat, or high protein diets (HC-, HF- or HP-rats, respectively) and adapted to a 5 hour feeding (11:00-16:00)-19 hour deprivation (16:00-11:00) schedule. Glucagon (540 mcg/kg body weight) was intraperitoneally injected at 14:00. Glucagon stimulated similar amounts of hepatic glycogenolysis in HC- and in HF-rats and less glycogenolysis in HP-rats, but glucagon decreased food intake only in HC-rats. When HF- or HP-rats were prefed the HC-diet once for 1 hour (11:00-12:00) prior to injection, glucagon stimulated hepatic glycogenolysis similarly in both groups but decreased food intake only in HF-rats. Therefore, stimulation of hepatic glycogenolysis by glucagon is not sufficient to elicit satiety under all feeding conditions. The results also suggest that glucagon-induced satiety is not limited to carbohydrate intake.

Apparent suicide by carbon monoxide poisoning in a case of insulinoma

A woman, found dead in her garage, had a fatal level of carboxyhaemoglobin in her blood. Her recent medical history tended to support a suspicion of suicide but at autopsy a small islet cell tumour was discovered in her pancreas. Further investigations indicated that she had a high blood insulin level, sufficient to produce lethargy or coma, at the time of death. In the light of these findings it was concluded that her death was accidental. The techniques available for investigating the significance of islet cell tumours found at post-mortem are discussed.

Insulin and myoelectric activity of the small intestine of the pig

The effect of insulin on the myoelectric activity of the small intestine was determined in conscious pigs. Animals were implanted with electrodes along the small intestine, a strain gage on the stomach and catheters in both saphenous arteries. Feeding modified the migrating myoelectric complex (MMC), a cyclic pattern of action potential activity of the small intestine characteristic of fasting. The first period of regular spiking activity (RSA) on the duodenum after feeding was delayed and was not followed by quiescence. Plasma insulin and glucose concentrations during the first three MMC after feeding were highest just before periods of duodenal RSA. Injection or infusion of insulin into fasted pigs with production of hypoglycemia caused disruption of stomach motility and duodenal electrical activity. The duodenal MMC was not altered when glucose to prevent hypoglycemia was infused together with insulin or when glucose was infused alone. These studies suggest that insulin is not directly responsible for the postprandial modification of MMC activity as insulin infusions only modify the MMC when hypoglycemia occurs.