Resistance to insulin-stimulated glucose uptake is present in the majority of patients with impaired glucose tolerance (IGT) or non-insulin-dependent diabetes mellitus (NIDDM) and in ∼25% of nonobese individuals with normal oral glucose tolerance. In these conditions, deterioration of glucose tolerance can only be prevented if the β-cell is able to increase its insulin secretory response and maintain a state of chronic hyperinsulinemia. When this goal cannot be achieved, gross decompensation of glucose homeostasis occurs. The relationship between insulin resistance, plasma insulin level, and glucose intolerance is mediated to a significant degree by changes in ambient plasma free-fatty acid (FFA) concentration. Patients with NIDDM are also resistant to insulin suppression of plasma FFA concentration, but plasma FFA concentrations can be reduced by relatively small increments in insulin concentration.Consequently, elevations of circulating plasma FFA concentration can be prevented if large amounts of insulin can be secreted. If hyperinsulinemia cannot be maintained, plasma FFA concentration will not be suppressed normally, and the resulting increase in plasma FFA concentration will lead to increased hepatic glucose production. Because these events take place in individuals who are quite resistant to insulinstimulated glucose uptake, it is apparent that even small increases in hepatic glucose production are likely to lead to significant fasting hyperglycemia under these conditions. Although hyperinsulinemia may prevent frank decompensation of glucose homeostasis in insulin-resistant individuals, this compensatory response of the endocrine pancreas is not without its price. Patients with hypertension, treated or untreated, are insulin resistant, hyperglycemic, and hyperinsulinemic. In addition, a direct relationship between plasma insulin concentration and blood pressure has been noted. Hypertension can also be produced in normal rats when they are fed a fructose-enriched diet, an intervention that also leads to the development of insulin resistance and hyperinsulinemia. The development of hypertension in normal rats by an experimental manipulation known to induce insulin resistance and hyperinsulinemia provides further support for the view that the relationship between the three variables may be a causal one. However, even if insulin resistance and hyperinsulinemia are not involved in the etiology of hypertension, it is likely that the increased risk of coronary artery disease (CAD) in patients with hypertension and the fact that this risk if not reduced with antihypertensive treatment are due to the clustering of risk factors for CAD, in addition to high blood pressure, associated with insulin resistance. These include hyperinsulinemia, IGT, increased plasma triglyceride concentration, and decreased high-density lipoprotein cholesterol concentration, all of which are associated with increased risk for CAD. It is likely that the same risk factors play a significant role in the genesis of CAD in the population as a whole. Based on these considerations the possibility is raised that resistance to insulin-stimulated glucose uptake and hyperinsulinemia are involved in the etiology and clinical course of three major related diseases— NIDDM, hypertension, and CAD.

Role of Insulin Resistance in Human Disease

Diabetes mellitus is commonly associated with systolic/diastolic hypertension, and a wealth of epidemiological data suggest that this association is independent of age and obesity. Much evidence indicates that the link between diabetes and essential hypertension is hyperinsulinemia. Thus, when hypertensive patients, whether obese or of normal body weight, are compared with age- and weight-matched normotensive control subjects, a heightened plasma insulin response to a glucose challenge is consistently found. A state of cellular resistance to insulin action subtends the observed hyperinsulinism. With the insulin/glucose-clamp technique, in combination with tracer glucose infusion and indirect calorimetry, it has been demonstrated that the insulin resistance of essential hypertension is located in peripheral tissues (muscle), is limited to nonoxidative pathways of glucose disposal (glycogen synthesis), and correlates directly with the severity of hypertension. The reasons for the association of insulin resistance and essential hypertension can be sought in at least four general types of mechanisms: Na+ retention, sympathetic nervous system overactivity, disturbed membrane ion transport, and proliferation of vascular smooth muscle cells. Physiological maneuvers, such as calorie restriction (in the overweight patient) and regular physical exercise, can improve tissue sensitivity to insulin; evidence indicates that these maneuvers can also lower blood pressure in both normotensive and hypertensive individuals. Insulin resistance and hyperinsulinemia are also associated with an atherogenic plasma lipid profile. Elevated plasma insulin concentrations enhance very-low-density lipoprotein (VLDL) synthesis, leading to hypertriglyceridemia. Progressive elimination of lipid and apolipoproteins from the VLDL particle leads to an increased formation of intermediate-density and low-density lipoproteins, both of which are atherogenic. Last, insulin, independent of its effects on blood pressure and plasma lipids, is known to be atherogenic. The hormone enhances cholesterol transport into arteriolar smooth muscle cells and increases endogenous lipid synthesis by these cells. Insulin also stimulates the proliferation of arteriolar smooth muscle cells, augments collagen synthesis in the vascular wall, increases the formation of and decreases the regression of lipid plaques, and stimulates the production of various growth factors. In summary, insulin resistance appears to be a syndrome that is associated with a clustering of metabolic disorders, including non-insulin-dependent diabetes mellitus, obesity, hypertension, lipid abnormalities, and atherosclerotic cardiovascular disease.

Insulin Resistance: A Multifaceted Syndrome Responsible for NIDDM, Obesity, Hypertension, Dyslipidemia, and Atherosclerotic Cardiovascular Disease

Biology of dairy cows during the transition period : the final frontier?

Molecular physiology of reverse cholesterol transport.

Loss of Insulin Signaling in Hepatocytes Leads to Severe Insulin Resistance and Progressive Hepatic Dysfunction

1. When livers from fed rats were perfused with blood containing elevated concentrations of rat insulin or blood to which fructose was added, the oxidation of free fatty acids was depressed and their esterification was increased. 2. Raised concentrations of insulin or addition of fructose increased secretion of triglyceride in very-low-density lipoproteins, but only insulin caused more of the free fatty acids taken up by the liver to be incorporated into very-low-density lipoproteins. 3. When insulin and fructose were added together the combined effect on oxidation and esterification of free fatty acids and on secretion of very-low-density lipoproteins was equal to the sum of the effects of either alone. No statistically significant interaction between the effects of fructose and insulin was found for any of the parameters investigated. 4. Bovine insulin had similar effects, in most respects, to comparable studies with raised concentrations of rat insulin. 5. Lipogenesis was increased in the livers treated with fructose plus bovine insulin. 6. A significant proportion of the fatty acids in very-low-density lipoproteins were derived either from the liver triglyceride pool or from lipogenesis. This fraction was increased both by treatment with insulin or fructose, and was augmented further when both insulin and fructose were present together. 7. The uptake of fructose by the perfused liver was similar to that found in vivo. It was unaffected by the presence of insulin. 8. Addition of fructose to the perfused liver caused perfusate lactate concentrations to increase, as a result of diminished hepatic uptake of lactate. 9. The uptake of free fatty acids by the perfused liver was unaffected by the addition of either insulin or fructose. 10. The distribution among the various lipid classes in plasma lipoproteins of label arising from the hepatic uptake of [(14)C]oleate was unaltered by the addition of either fructose or insulin. 11. It is suggested that the effects described are due principally to control of the balance between esterification of fatty acids and lipolysis of the ensuing triglyceride, fructose enhancing esterification and insulin inhibiting lipolysis.

The immediate effects of insulin and fructose on the metabolism of the perfused liver. Changes in lipoprotein secretion, fatty acid oxidation and esterification, lipogenesis and carbohydrate metabolism

https://febs.onlinelibrary.wiley.com/doi/pdf/10.1016/0014-5793%2877%2980693-5

Acute effects of insulin on glycerol phosphate acyl transferase activity, ketogenesis and serum free fatty acid concentration in perfused rat liver

1. Acetone-dried powders of liver and heart tissues from rats given a high-carbohydrate diet or a fat meal were assayed for lipoprotein lipase activity. Heart tissue showed typical lipoprotein lipase activity, whereas none was detected in liver by the usual assay procedures. 2. When mixed acetone-dried powders were prepared from heart plus liver, there was a marked suppression of the expected activity, indicating that an inhibitor was present in the liver. This inhibition was partially overcome in the presence of relatively large amounts of heparin. 3. Lipoprotein lipase was also detected in liver alone when large quantities of heparin were added to the assay system. 4. No increase in lipoprotein lipase activity in either liver or heart was detected when rats were given a fat meal. 5. It is concluded that the liver of the rat contains lipoprotein lipase that is normally present in an inactive state. The results imply that a heparinase is the agent responsible for the inactivation. 6. The significance of the non-functional status of lipoprotein lipase in the liver is discussed. The results support the view that direct hydrolysis of plasma triglycerides by the liver is not a significant physiological process.

/pdf/the-functional-status-of-lipoprotein-lipase-in-rat-liver-2hoqyh9hb7.pdf

The functional status of lipoprotein lipase in rat liver.

Comparison of the hepatic uptake and processing of cholesterol from chylomicrons of different fatty acid composition in the rat in vivo.

1. Livers from rats fed on a standard diet were perfused with whole blood, and infused continuously with glucose and fructose at equimolar rates.2. Infusion of fructose increased both the secretion of very-low-density-lipoprotein (VLDL)-triglycerides and the incorporation of free fatty acids (FFA) from the perfusate into VLDL-lipids, but neither of these two processes was affected by infusion of glucose.3. Infusion of fructose decreased the oxidation and increased the esterification of FFA, but glucose infusion had no effect on these processes. When fructose and glucose were infused together there was a further decrease in oxidation.4. When fructose was infused alone or together with glucose, blood concentrations rapidly became stabilized at those found in the hepatic portal vein in vivo, with similar rates of hepatic uptake to those found in the intact animal. Infusion of glucose alone resulted in continuously increasing perfusate glucose concentrations, and rates of uptake which were only 20 % of those for fructose. Blood glucose concentrations were reduced, and lactate concentrations were increased by fructose infusion, and when glucose and fructose were infused together there was a greatly increased rate of glucose uptake.5. Liver glycogen was not affected by the infusion of fructose or glucose alone; however, their combined addition significantly increased its concentration.6. Uptake of perfusate FFA was not affected by either fructose or glucose infusions.7. The results are discussed in terms of the differences in nutrition and metabolism between glucose and fructose, with particular reference to the development of hyper- triglyceridaemia.

/pdf/comparative-effects-of-fructose-and-glucose-on-the-lipid-and-35yc1obyjs.pdf

Peter A. Mayes

Papers

The immediate effects of insulin and fructose on the metabolism of the perfused liver. Changes in lipoprotein secretion, fatty acid oxidation and esterification, lipogenesis and carbohydrate metabolism

Acute effects of insulin on glycerol phosphate acyl transferase activity, ketogenesis and serum free fatty acid concentration in perfused rat liver

The functional status of lipoprotein lipase in rat liver.

Comparison of the hepatic uptake and processing of cholesterol from chylomicrons of different fatty acid composition in the rat in vivo.

Comparative effects of fructose and glucose on the lipid and carbohydrate metabolism of perfused rat liver.