The effect of insulin on the disposal of intravenous glucose was examined employing the euglycemic insulin clamp technique in 24 normal subjects. When the plasma insulin concentration was raised by approximately 100 μU/ml, total glucose metabolism rose to 6.63 ± 0.38 mg/kg · min. Basal splanchnic (hepatic venous catheter technique) glucose production, 2.00 increased only slightly. These results suggest that the ability of higher doses of insulin to further stimulate glucose metabolism is primarily the result of increased glucose storage by peripheral tissues, most likely muscle. 0.15 ± mg/kg · min, reverted to a small net glucose uptake which averaged 0.33 mg/kg · min over the ensuing 2 h. This represented only 5% of the total glucose metabolized. In contrast, leg (femoral venous catheterization) glucose uptake rose from 1.18 ± 0.14 to 8.40 ± 1.06 mg/kg of leg wt. per min. If all muscles in the body respond similarly to those in the leg, muscle would account for 85% of the total glucose metabolism. To determine the relative contributions of glucose oxidation versus glucose storage by peripheral tissues following hyperinsulinemia, we performed euglycemic insulin clamp studies in combination with indirect calorimetry. Basal glucose oxidation, 1.21 ± 0.10 mg/kg min, rose to 2.28 ± 0.16 (P < 0.01), and this increase above baseline accounted for only 20% of the total glucose metabolized, 5.44 ± 0.38 mg/kg · min. Following insulin, glucose storage increased to 3.18 ± 0.34 mg/kg min and was responsible for 59% of the total glucose metabolized. These results indicate that the primary effect of insulin on muscle tissue is to enhance glucose storage, presumably as glycogen. When a higher degree of hyperinsulinemia (163 ± 19 μl/ml) was created while maintaining euglycemia, total glucose metabolism (7.99 ± 0.58) and glucose storage (5.30 ± 0.80) both increased (P < 0.01) compared with the lower dose insulin clamp study, but glucose oxidation (2.70 ± 0.16 mgμkg min)increased only slightly. These results suggest that the ability of higher doses of insulin to further stimulate glucose metabolism is primarily the result of increased glucose storage by peripheral tissues, most likely muscle.

The dose-response relationship between plasma insulin concentration and total glucose uptake, glucose oxidation, and glucose storage was examined in 22 healthy young volunteers by employing the euglycemic insulin clamp technique in combination with indirect calorimetry. Insulin was infused at five rates to achieve steady-state hyperinsulinemic plateaus of 62 ± 4, 103 ± 5, 170 ± 10, 423 ± 16, and 1132 ± 47 μU/ml. With increasing plasma insulin concentrations within the physiologic range, there was a linear increase in glucose uptake with a half maximally effective insulin concentration of 72 μU/ml. Glucose uptake by all tissues of the body reached 80% of its maximum value (12.6 mg/kg · min) at a plasma insulin concentration of ∼200 μU/ml. In contrast to total glucose uptake, glucose oxidation plateaued more quickly, achieved a maximum rate of only 4.0 mg/kg · min, and displayed a lower half maximally effective insulin concentration of 40 μU/ml. The increase in glucose uptake with progressively increasing plasma insulin levels was primarily the result of an increase in glucose storage, with a half maximally effective insulin concentration of 105 μU/ml and maximum rate of 8.7 mg/kg · min. Glucose storage represented over 60–70% of total glucose uptake at all insulin concentrations. After achieving maximum rates of insulin-mediated glucose uptake (plasma insulin concentration = 1132 μU/ml), hyperglycemia (+125 mg/dl) was superimposed on hyperinsulinemia to further enhance glucose transport. Under these conditions, total glucose uptake (32.5 mg/kg · min, P < 0.001) was markedly augmented but no significant increase in glucose oxidation was observed. These results indicate a true saturation of the glucose oxidation pathway. With pro-gressively increasing doses of insulin, the glucose storage represents the major route of glucose disposal.

No abstract

The glucose-induced thermogenesis (GIT) following a 100-g oral glucose load has been measured by continuous indirect calorimetry in 55 nondiabetic and diabetic obese subjects of various ages and compared with two control groups of 17 young and 13 elderly nonobese subjects. The obese subjects were divided into four groups: group A, normal glucose tolerance; group B, impaired glucose tolerance; group C, diabetes with increased insulin response; group D, diabetes with reduced insulin response. The glucose-induced thermogenesis measured during 3 h represented 8.6 ± 0.7% of the energy content of the load in the young control group. In all obese groups, the glucose-induced thermogenesis was significantly lower than in the young control group, i.e., 6.6 ± 0.9%, 6.4 ± 0.6%, 3.7 ± 0.7%, and 2.2 ± 0.4% in groups A, B, C, and D, respectively. Since the obese diabetics were older than the other groups, their glucose-induced thermogenesis was compared with that of the elderly control group; the latter (5.8 ± 0.3%) was significantly lower (P < 0.05) than that of the young control group. The obese diabetics also had a significantly lower glucose-induced thermogenesis than the elderly control group (P < 0.02 and P < 0.001 for groups C and D, respectively). When corrected for glucosuria and after taking into account the glucosuria and the changes in the glucose space, the corrected glucose-induced thermogenesis (i.e., related to glucose “uptake”), was still significantly reduced in group A versus the young control group (6.6 ± 0.9 versus 8.6 ± 0.7%, P < 0.05), and in group D versus the elderly (matched for age) control group (4.2 ± 0.7 versus 5.8 ± 0.3%, P < 0.05). It is concluded that the postprandial thermogenesis induced by glucose ingestion is decreased in the presence of insulin resistance and/or reduced insulin response to the glucose load in obese subjects. In addition, age itself contributes to decrease glucose-induced thermogenesis.