Both glucose and insulin are important regulators of glucose uptake and hepatic glucose release. Because insulin concentrations rarely if ever increase under daily living conditions, unless glucose concentrations also increase, we sought to determine whether hepatic and extrahepatic responses to changes in insulin and glucose concentration are impaired in patients with non-insulin-dependent diabetes mellitus (NIDDM). To address this question, glucose metabolism was measured in diabetic and nondiabetic subjects. A computer-driven infusion system was used to produce a nondiabetic postprandial insulin profile in both groups while sufficient exogenous glucose was infused to mimic nondiabetic postprandial glucose concentrations. Although NIDDM was associated with greater (P < 0.05) hepatic glucose release both before and during the prandial insulin infusion, suppression did not differ in the diabetic and nondiabetic subjects (−1.06 ± 0.20 vs. −0.86 ± 0.15 mmol/kg every 4 h). In contrast, stimulation of both glucose disappearance (0.77 ± 0.27 vs. 1.68 ± 0.27 mmol/kg every 4 h) and forearm glucose uptake (187 ± 81 vs. 550 ± 149 μmol/dl every 4 h) was lower (P < 0.05) in diabetic than in nondiabetic subjects. Thus, despite increased basal rates of glucose production, obese individuals with NIDDM had decreased stimulation of glucose disappearance but normal suppression of hepatic glucose release in response to nondiabetic prandial glucose and insulin concentrations. These data indicate that the increase in glucose that occurs with carbohydrate ingestion is likely to compensate for hepatic but not extrahepatic insulin resistance.
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Original Articles|
February 01 1994
Assessment of Insulin Action in NIDDM in the Presence of Dynamic Changes in Insulin and Glucose Concentration
Harold Katz;
Harold Katz
Endocrine Research Unit, Department of Medicine
Mayo Clinic, Rochester, Minnesota
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Mal Homan;
Mal Homan
Endocrine Research Unit, Department of Medicine
Mayo Clinic, Rochester, Minnesota
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Michael Jensen;
Michael Jensen
Endocrine Research Unit, Department of Medicine
Mayo Clinic, Rochester, Minnesota
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Andrea Caumo;
Andrea Caumo
San Raffaele Scientific Institute
Milan, Italy
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Claudio Cobelli;
Claudio Cobelli
Department of Electronics and Informatics, University of Padua
Padua
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Robert Rizza
Robert Rizza
Endocrine Research Unit, Department of Medicine
Mayo Clinic, Rochester, Minnesota
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Address correspondence and reprint requests to Dr. Robert A Rizza, Endocrine Research Unit, 5–164 West Joseph, Mayo Clinic, Rochester, MN 55905.
Diabetes 1994;43(2):289–296
Article history
Received:
February 26 1993
Revision Received:
September 03 1993
Accepted:
September 03 1993
PubMed:
8288053
Citation
Harold Katz, Mal Homan, Michael Jensen, Andrea Caumo, Claudio Cobelli, Robert Rizza; Assessment of Insulin Action in NIDDM in the Presence of Dynamic Changes in Insulin and Glucose Concentration. Diabetes 1 February 1994; 43 (2): 289–296. https://doi.org/10.2337/diab.43.2.289
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