Hepatic and Extrahepatic Responses to Insulin in NIDDM and Nondiabetic Humans: Assessment in Absence of Artifact Introduced by Tritiated Nonglucose Contaminants

It is well established that patients with non-insulindependent diabetes mellitus (NIDDM) are resistant to insulin. However, the contribution of hepatic and extrahepatic tissues to insulin resistance remains controversial. The uncertainty may be at least in part due to errors introduced by the unknowing use in previous studies of impure isotopes to measure glucose turnover. To determine hepatic and extrahepatic responses to insulin in the absence of these errors, steady-state glucose turnover was measured simultaneously with [6-³H]- and [6-¹⁴C]glucose during sequential 5- and 4-h infusions of insulin at rates of 0.4 and 10 mil · kg⁻¹ · min⁻¹ in diabetic and nondiabetic subjects. At low insulin concentrations, [6-³H]- and [6-¹⁴C]glucose gave similar estimates of glucose turnover. Hepatic glucose release was equal to but not below zero in the nondiabetic subjects, but persistent glucose release (P < 0.001) and decreased glucose uptake (P < 0.001) was observed in the diabetic patients. At high insulin concentrations, both isotopes underestimated glucose turnover during the 1st h after initiation of the highdose insulin infusion. More time (P < 0.05) was required to reachieve steady state in NIDDM than nondiabetic subjects. At steady state, [6-³H] but not [6-¹⁴C]glucose systematically underestimated (P < 0.05) glucose turnover in both groups due to the presence of a tritiated nonglucose contaminant. The percentage of radioactivity in plasma due to tritiated contaminants was linearly related to turnover. When plasma [6-³H]glucose specific activity was corrected for the presence of the contaminant in each subject, both [6-³H]- and [6-¹⁴C]glucose indicated that diabetic patients had hepatic and extrahepatic insulin resistance. We conclude that in these experiments, although the presence of a low percentage of tritiated nonglucose contaminant in the tracer may alter estimates of the severity of hepatic and extrahepatic insulin resistance in patients with NIDDM, it does not obscure their presence