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  • 1
    ISSN: 1432-0428
    Keywords: Standard oral glucose tolerance test ; splanchnic glucose output ; splanchnic glucose retention ; insulin production rate ; non-esterified fatty acids ; glucagon ; pancreatic polypeptide
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To determine the effect of the 75 g oral glucose tolerance test on carbohydrate and lipid metabolism, the splanchnic exchange of glucose, lactate, pyruvate, non-esterified fatty acids, β- hydroxybutyrate and acetoacetate as well as the release of insulin, C-peptide, glucagon and pancreatic polypeptide were evaluated in eight healthy male volunteers in the basal state and for 150 min following glucose ingestion. Oral glucose loading was followed by a rapid rise in splanchnic output of glucose (mean±SEM; 154±12 mmol/150 min), pyruvate (1.2±1.2 mmol/150 min) and lactate (8.6±2.0 mmol/150 min), whereas there were reductions in the splanchnic uptake of non-esterified fatty acids (-10.7±4.4 mmol/150 min) and the splanchnic output of β-hydroxybutyrate (-4.8±3.3 mmol/150 min) and acetoacetate (-3.0±1.2 mmol/150 min). In parallel, splanchnic output of insulin (12.3±2.7 nmol/150 min), C-peptide (36.1±5.0 nmol/ 150 min) and transiently of pancreatic polypeptide rose, whereas that of glucagon fell (-0.58±0.21 nmol/150 min). Even at 150 min after glucose ingestion, splanchnic ouptut and arterial concentrations of glucose, lactate, insulin and C-peptide were still above their respective basal values while those of non-esterified fatty acids and glucagon were reduced. Taking into account the partial suppression of endogenous glucose production by ingested glucose it is concluded that, in normal postabsortive man, only 49–63% of a 75 g oral glucose load is retained by the splanchnic bed during the first 150 min, the rest being available for non-hepatic tissues. Since typical metabolic responses to oral glucose loading were maintained up to 150 min after glucose ingestion, it appears that glucose absorption from the gut was not yet complete within this time. This finding partially jeopardizes the interpretation of calculated post-prandial hepatic glucose uptake for short observation periods.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0428
    Keywords: Obesity ; Type 2 diabetes ; hyperinsulinaemia ; insulin production rate ; splanchnic insulin retention ; splanchnic glucose output ; insulin resistance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To differentiate peripheral and hepatic insulin resistance in hyperinsulinaemic overweight Type 2 (non-insulin-dependent) diabetic patients (n = 17; 143±4% ideal body weight; mean±SEM) arterial concentrations and splanchnic exchange of glucose, pyruvate, lactate, non-esterified fatty acids, β-hydroxybutyrate and acetoacetate, as well as the insulin production rate, were determined before and during oral glucose loads of 25 g or 100 g. Insulin production rate, hepatic insulin retention and splanchnic exchange of glucose and metabolites were estimated by means of the hepatic venous catheter technique. In the basal state insulin production rate was greater in overweight Type 2 diabetic patients (2.57±0.28 pmol.kg-1. min-1) than in healthy control subjects (1.68±0.17 pmol.kg-1. min-1; p〈0.01). After ingestion of 25 g glucose, the cumulative insulin production rate exceeded normal values (p 〈 0.05), but was below normal with 100 g glucose (p 〈 0.01). Relative insulin trapping by the splanchnic bed in the diabetic patients was 54±3%, not different from normal. Following a 100 g glucose load, splanchnic insulin retention fell by 20% in the patients, and less consistently so in healthy controls. Splanchnic glucose output was normal in the diabetic patients both in the basal state and after glucose ingestion although the induced arterial blood glucose levels were greater in the diabetic patients than in control subjects (p 〈 0.005). Splanchnic output of pyruvate (p 〈 0.025), lactate (p 〈 0.01), and β-hydroxybutyrate (p 〈 0.005) were greater in the basal state in the diabetic patients than in healthy subjects. However, no difference in splanchnic exchange was seen between the two groups in their metabolites' respective response to glucose ingestion. These data suggest that obese hyperinsulinaemic Type 2 diabetic patients may represent a subgroup of diabetic patients with predominantly peripheral, but compensated hepatic, insulin resistance being associated with an increased basal insulin production rate which only exhausts after ingestion of a large glucose load.
    Type of Medium: Electronic Resource
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