Effect of euglycaemic hyperinsulinaemia on gastric emptying and gastrointestinal hormone responses in normal subjects

Abstract

Gastric emptying of solid and/or nutrient liquid meals is delayed in up to 50 % of patients with longstanding diabetes mellitus [1]. In addition, the blood glucose response to oral carbohydrate is related to the rate of gastric emptying of a carbohydrate load in both normal subjects and patients with diabetes. Gastric emptying may therefore be a previously under-recognized contributor to variations in glycaemic control which can have an impact on the management of patients with diabetes. Thus an understanding of the various factors influencing gastric emptying is important.Hyperglycaemia delays gastric emptying in both patients with diabetes and in healthy subjects [2±4]. The mechanisms involved are uncertain, but concomitant hyperinsulinaemia may have some effect. Eliasson et al. [5] reported that gastric emptying was slower during hyperinsulinaemia but only four subjects were studied and only a solid meal was used. Ideally, both solid and nutrient-liquid emptying should be measured because it is not unusual for an emptying abnormality to be limited to either the solid or liquid component of a meal. In the normal state, solids empty differently from liquids; emptying of solids is thought to be a function of propulsive and retropulsive mincing action of the antrum whereas liquid emptying seems to depend primarily on gastric tone [6,7]. Diabetologia (1998) Summary Several studies have shown that hyperglycaemia slows gastric emptying in normal subjects and patients with diabetes mellitus but whether hyperinsulinaemia per se has an effect remains debatable. In the present study we have assessed the effect of hyperinsulinaemia on gastric emptying of a solid and liquid meal in normal subjects. Ten men were studied three times in random order. After an overnight fast, subjects were infused with 0.9 % NaCl on two occasions and on the third with insulin, at 40 mU × m 2 × min 1 with 20 % glucose simultaneously to maintain euglycaemia. Steady-state glucose infusion rate was ensured before the subjects ate a standard meal of a pancake labelled with In-DTPA. Gamma-scintigraphic images were then obtained every 20 min for the next 3 h. There were no significant differences between the mean half-emptying times (T 50 ) of the solid and liquid during the two saline infusions (129.6 ± 28.5 vs 128.4 ± 23.8 min for the solid and 25.4 ± 7.0 vs 34.7 ± 18.0 min for the liquid, mean ± SD). Hyperinsulinaemia delayed both solid (mean T 50 149.6 ± 30.7, p = 0.031) and liquid emptying (mean T 50 39.8 ± 13.9, p = 0.042). There were no significant differences in the cholecystokinin and glucagon-like peptide 1 responses to the meal during either saline or insulin infusions. There was a tendency towards a greater insulin response to the meal during the hyperinsulinaemic study. Thus, hyperinsulinaemia delayed emptying of both the solid and liquid components of the meal.[ Diabetologia (1998) 41: 474±481]

Euglycaemic hyperinsulinaemia does not affect gastric emptying in Type I and Type II diabetes mellitus

“…Gastric emptying results were compared with those obtained in 10 healthy male volunteers (weight 79.2 ± 8.2 kg, range 61.8±86.5, BMI 25.5 ± 2.5 kg/m 2 , mean ± SD), aged 23.6 ± 3.4 years (20±32) who underwent measurements of gastric emptying during euglycaemic hyperinsulinaemia, with an insulin infusion rate of 40 mU × m ±2 × min ±1 . The results of gastric emptying in these subjects have been reported previously [20]. In this latter group the solid T 50 was 149.6 ± 30.7 min (range 92±195 min) and proximal and distal R 100 were 53 ± 10 % and 14 ± 5 %.…”

“…The effects of insulin on gastrointestinal motor function are controversial [16,20,21, 37±40]. The serum insulin concentrations that we evaluated are comparable with those achieved during ªmarkedº and ªphysiologicalº hyperglycaemia in normal subjects [16,20,21].…”

“…[Diabetologia (1999) 42: 365±372] Keywords Type I diabetes, Type II diabetes, euglycaemia, hyperinsulinaemia, gastric emptying. both solid and liquid meal components of a meal [20,21], although in the most recent of these studies [20] the magnitude of this slowing was small, albeit statistically significant. The effects of hyperinsulinaemia on gastric emptying in patients with diabetes mellitus have not been evaluated, although there is some evidence that the magnitude of the delay in gastric emptying associated with acute hyperglycaemia is possibly less in diabetic patients when compared with normal subjects [15,22].…”

“…One cannula was inserted into an antecubital vein for infusion of glucose and insulin and another, retrogradely, into a vein on the dorsum of the dominant hand. The latter was kept patent with a slow infusion of 0.9 % NaCl and the hand rested in a heated box (55±60°C) so that ªarterializedº venous blood samples could be obtained [20].…”

Impaired Hyperglycemia-Induced Delay in Gastric Emptying in Patients With Type 1 Diabetes Deficient for Islet Amyloid Polypeptide

“…In studies suggesting that insulin may be another important regulator of gastric emptying in healthy volunteers (19), the effects of hyperinsulinemia on gastric emptying were found to be marginal (19). Interestingly, in studies undertaken in patients with type 1 diabetes, no effect of insulin on gastric emptying was detected (20).…”