Kehlenbrink S, Tonelli J, Koppaka S, Chandramouli V, Hawkins M, Kishore P. Inhibiting gluconeogenesis prevents fatty acid-induced increases in endogenous glucose production. Am J Physiol Endocrinol Metab 297: E165-E173, 2009. First published May 5, 2009 doi:10.1152/ajpendo.00001.2009.-Glucose effectiveness, the ability of glucose per se to suppress endogenous glucose production (EGP), is lost in type 2 diabetes mellitus (T2DM). Free fatty acids (FFA) may contribute to this loss of glucose effectiveness in T2DM by increasing gluconeogenesis (GNG) and impairing the response to hyperglycemia. Thus, we first examined the effects of increasing plasma FFA levels for 3, 6, or 16 h on glucose effectiveness in nondiabetic subjects. Under fixed hormonal conditions, hyperglycemia suppressed EGP by 61% in nondiabetic subjects. Raising FFA levels with Liposyn infusion for Ն3 h reduced the normal suppressive effect of glucose by one-half. Second, we hypothesized that inhibiting GNG would prevent the negative impact of FFA on glucose effectiveness. Raising plasma FFA levels increased gluconeogenesis by ϳ52% during euglycemia and blunted the suppression of EGP by hyperglycemia. Infusion of ethanol rapidly inhibited GNG and doubled the suppression of EGP by hyperglycemia, thereby restoring glucose effectiveness. In conclusion, elevated FFA levels rapidly increased GNG and impaired hepatic glucose effectiveness in nondiabetic subjects. Inhibiting GNG could have therapeutic potential in restoring the regulation of glucose production in type 2 diabetes mellitus.free fatty acids; hyperglycemia; diabetes mellitus FASTING HYPERGLYCEMIA IN TYPE 2 DIABETES MELLITUS (T2DM) is characterized by increased endogenous glucose production (EGP) (11, 16) predominantly due to increased gluconeogenesis (GNG) (2, 47). Considerable evidence has shown potent direct effects of glucose to suppress EGP in healthy individuals (6,17,31), with marked suppression even in the absence of an insulin response (48). Loss of this "glucose effectiveness" contributes significantly to increased EGP (19,31,33). Elevated circulating free fatty acid (FFA) levels appear to play a pivotal role in the loss of glucose effectiveness in T2DM (2, 47), since FFAs increase EGP by stimulating GNG and by affecting key regulatory enzymes (1,24,25,30).Therefore, we wished to define 1) the time-dependent effects of raising FFA on glucose effectiveness in nondiabetic individuals, 2) the extent to which an increase in GNG is responsible for these defects, and 3) whether EGP can be inhibited in the presence of elevated plasma FFA by inhibiting GNG with ethanol. Our results confirm the striking effects of elevated plasma FFA to impair glucose effectiveness and suggest that increased GNG contributes importantly to this loss of regulation.
RESEARCH DESIGN AND METHODS
Subject CharacteristicsEighteen healthy subjects (13 men and 5 women) were recruited. Informed, written consent was obtained in accordance with the policies of the Institutional Committee on Clinical Investigations at the Al...