Hepatic glucose autoregulation: responses to small, non-insulin-induced changes in arterial glucose

Impaired plasma glucose clearance is a key determinant of fasting hyperglycemia in people with obesity

OBJECTIVE

The objective of this study was to evaluate the relative importance of the basal rate of glucose appearance (Ra) in the circulation and the basal rate of plasma glucose clearance in determining fasting plasma glucose concentration in people with obesity and different fasting glycemic statuses.

METHODS

The authors evaluated basal glucose kinetics in 33 lean people with normal fasting glucose (<100 mg/dL; Lean < 100 group) and 206 people with obesity and normal fasting glucose (Ob < 100 group, n = 118), impaired fasting glucose (100-125 mg/dL; Ob 100-125 group, n = 66), or fasting glucose diagnostic of diabetes (≥126 mg/dL; Ob ≥ 126 group, n = 22).

RESULTS

Although there was a large (up to three-fold) range in glucose Ra within each group, the ranges in glucose concentration in the Lean < 100, Ob < 100, and Ob 100-125 groups were small because of a close relationship between glucose Ra and clearance rate. However, the glucose clearance rate at any Ra value was lower in the hyperglycemic than the normoglycemic groups. In the Ob ≥ 126 group, plasma glucose concentration was primarily determined by glucose Ra, because glucose clearance was markedly attenuated.

CONCLUSIONS

Fasting hyperglycemia in people with obesity represents a disruption of the precisely regulated integration of glucose production and clearance rates.

Participation in a 1,000-mile race increases the oxidation of carbohydrate in Alaskan sled dogs

The Alaskan Husky has been specifically bred for endurance performance and is capable of extreme endurance performance. We examined sled dogs in the trained state at the beginning of the race season and after a 1,600-km race (Iditarod). Our hypothesis was that lipids would be the predominant substrate during submaximal exercise in long-distance racing sled dogs, and a 1,600-km race would increase the reliance on lipids during an exercise bout at the same absolute exercise intensity. The experiments were completed over three testing periods, which were completed in January of two different years before participation in a 1,600-km race, or in March shortly after completion of a 1,600-km race. After determination of H(13)CO3 (-) recovery, the dogs were tested with primed continuous infusions of [1,1,2,3,3-(2)H]glycerol, [3-(13)C]lactate, or [6,6-(2)H2]glucose. During exercise, respiratory exchange ratio was significantly higher in raced (0.92 ± 0.01) compared with nonraced (0.87 ± 0.01) dogs. During exercise, glucose rate of appearance was potentially sustained by a large glycerol rate of disappearance with an increase in lactate rates of oxidation after a 1,600-km race. Therefore, contrary to our hypothesis, the sled dogs were dependent on carbohydrate energy sources, a reliance that increased further after participation in a 1,600-km race.

Chemical induction of the unfolded protein response in the liver increases glucose production and is activated during insulin-induced hypoglycaemia in rats

AIMS/HYPOTHESIS

Endoplasmic reticulum (ER) stress and the unfolded protein response (UPR) can regulate insulin secretion, insulin action and in vitro hepatocyte glucose release. The aims of this study were to determine whether chemical agents that induce ER stress regulate glucose production in vivo and to identify a physiological setting in which this may be important.

METHODS

A pancreatic clamp test was performed in anaesthetised rats, and insulin and glucagon were replaced at basal levels. [6,6-(2)H(2)]Glucose was infused in the absence (CON, n = 10) or presence of ER stress-inducing agents, namely, tunicamycin (Tun, n = 10) or thapsigargin (Thap, n = 10).

RESULTS

Arterial insulin, glucagon, corticosterone and NEFA concentrations were constant throughout experiments and not different among groups. After 1 h, the glucose concentration was significantly increased in Tun and Thap rats (1.5 +/- 0.2 and 2.1 +/- 0.3 mmol/l, respectively; mean +/- SD), but did not change in CON rats. Glucose production increased (p < 0.05) by 11.0 +/- 1.6 and 13.2 +/- 2.2 micromol kg(-1) min(-1) in Tun and Thap rats, respectively, but did not change in CON rats. When glucose was infused in a fourth group (HYPER) to match the increase in glucose observed in the Tun and Thap rats, glucose production decreased by approximately 22 micromol kg(-1) min(-1). Liver phosphorylase activity was increased and glycogen decreased in the Tun and Thap groups compared with the CON and HYPER groups. Given that glucose deprivation induces ER stress in cells, we hypothesised that hypoglycaemia, a condition that elicits increased glucose production, would activate the UPR in the liver. Three hour hyperinsulinaemic (5 mU kg(-1) min(-1)) -euglycaemic (EUG, approximately 7.2 mmol/l, n = 6) or -hypoglycaemic (HYPO, approximately 2.8 mmol/l, n = 6) clamps were performed in conscious rats. Several biochemical markers of the UPR were significantly increased in the liver, but not in kidney or pancreas, in HYPO vs EUG rats.

CONCLUSIONS/INTERPRETATION

Based on our findings that the chemical induction of the UPR increased glucose production and that prolonged hypoglycaemia activated the UPR in the liver, we propose that the UPR in the liver may contribute to the regulation of glucose production during prolonged hypoglycaemia.