scispace - formally typeset
Search or ask a question

Showing papers on "Insulin published in 1982"


Journal ArticleDOI
TL;DR: In women, the sites of fat predominance offer an important prognostic marker for glucose intolerance, hyperinsulinemia, and hypertriglyceridemia, may be related to the disparate morphology and metabolic behavior of fat cells associated with different body fat distributions.
Abstract: The importance of body fat distribution as a predictor of metabolic aberrations was evaluated in 9 nonobese and 25 obese, apparently healthy women. Plasma glucose and insulin levels during oral glucose loading were significantly higher in women with predominantly upper body segment obesity than in women with lower body segment obesity. Of the former group, 10 of 16 subjects had diabetic glucose tolerance results, while none of the latter group was diabetic. Fasting plasma triglyceride levels were also significantly higher in the upper body segment obese women. The site of adiposity in the upper body segment obese women was comprised of large fat cells, while in the lower body segment obese subjects, it was formed of normal size cells. In both types of obesity, abdominal fat cell size correlated significantly with postprandial plasma glucose and insulin levels. Thigh fat cell size gave no indication as to the presence of metabolic complications. Thigh adipocytes were also resistant to epinephrine-stimulated lipolysis, presumably due to an increase in alpha-adrenergic receptors. Thus, in women, the sites of fat predominance offer an important prognostic marker for glucose intolerance, hyperinsulinemia, and hypertriglyceridemia. This association may be related to the disparate morphology and metabolic behavior of fat cells associated with different body fat distributions.

1,805 citations


Journal ArticleDOI
08 Jan 1982-Science
TL;DR: Phosphorylation was specifically stimulated by insulin in a dose-dependent fashion after 1 and 15 minutes of hormone treatment, whereas human growth hormone was without effect, suggesting this phosphorylation may be a very early event in insulin action.
Abstract: Cultured human lymphocytes and rat hepatoma cells were labeled with [32P]orthophosphate and the insulin receptor subunits identified by immunoprecipitation and sodium dodecyl sulfate-gel electrophoreses. In both cell types the 95,000-dalton (beta) subunit of the insulin receptor was selectively phosphorylated. Phosphorylation was specifically stimulated by insulin in a dose-dependent fashion after 1 and 15 minutes of hormone treatment, whereas human growth hormone was without effect. This phosphorylation may be a very early event in insulin action.

1,088 citations


Journal ArticleDOI
TL;DR: A number of clinical studies have been performed in an attempt to dissect the particular component or components of the diabetic state responsible for these early elevations in glomerular filtration rate, and no single factor appears to account fully for this phenomenon.

819 citations



Journal ArticleDOI
TL;DR: The results indicate that the cortisol-induced insulin resistance in man is due to the decrease in both hepatic and extrahepatic sensitivity to insulin.
Abstract: The present studies were undertaken to assess the mechanisms responsible for cortisol-induced insulin resistance in man The insulin dose-response characteristics for suppression of glucose production and stimulation of glucose utilization and their relationship to monocyte and erythrocyte insulin receptor binding were determined in six normal volunteers after 24-h infusion of cortisol and 24-h infusion of saline The infusion of cortisol (2 /µg kg-1 min-1) increased the plasma cortisol concentration approximately 4-fold (37 ± 3 us 14 ± 1 µg/dl; P < 001) to values observed during moderately severe stress in man This hypercortisolemia increased postabsorptive plasma glucose (126 ± 2 us 97 ± 2 mg/dl; P < 001) and plasma insulin (16 ± 2 us 10 ± 2 µU/ml; P < 001) concentrations and rates of glucose production (24 ± 01 us 21 ± –01 mg kg-1 min-1; P < 001) and utilization (25 ± 01 us 21 ± 01 mg kg-1 min-1; P < 001) Insulin dose-response curves for both suppression of glucose production (half-

700 citations


Journal Article
TL;DR: The effects of hyperinsulinemia and hyperglycemia on peripheral glucose uptake, hepatic glucose production, and splanchnic glucose uptake in man and the effects of somatostatin and glucagon replacement on these areas are investigated.

542 citations


Journal ArticleDOI
TL;DR: The results show that insulin resistance is a common feature of both types of diabetes and can be demonstrated in the basal as well as the insulin-stimlated state, and both hepatic and peripheral resistance to the action of insulin contribute to diabetic hyperglycaemia.
Abstract: Hepatic glucose production (3H-glucose technique) and insulin-mediated glucose uptake (insulin clamp technique) were measured in 38 Type 2 (non-insulin-dependent) and 11 Type 1 (insulin-dependent) diabetic patients. Fasting plasma glucose concentration was 8.3 +/- 0.5 mmol/l in the former, and 9.6 +/- 1.3 mmol/l in the latter group; the respective fasting plasma insulin levels were 19 +/- 2 mU/l (p less than 0.005 versus 13 +/- 1 mU/l in 33 age-matched control subjects), and 9 +/- mU/l (p less than 0.01 versus 14 +/- 1 mU/l in 36 younger control subjects). In the fasting state, hepatic glucose production was slightly increased (15%, 0.1 greater than p greater than 0.05) in the Type 2 diabetic patients and markedly elevated (65%, p less than 0.001) in the Type 1 patients compared with their respective control groups. In both groups of diabetic subjects, the rates of hepatic glucose production were inappropriately high for the prevailing plasma glucose and insulin levels, indicating the presence of hepatic resistance to insulin. Basal plasma glucose clearance was also significantly reduced in both the Type 2 (34%) and the Type 1 (14%) diabetic subjects. The fasting plasma glucose concentration correlated directly with hepatic glucose production, and inversely with plasma glucose clearance. During the insulin clamp, plasma insulin was maintained at approximately 100 mU/l in all groups, while plasma glucose was maintained constant at the respective fasting levels. Total glucose uptake was reduced in both the Type 2 (4.57 +/- 0.31 versus 6.39 +/- 0.25 mg . min -1 . kg -1 in the control subjects, p less than 0.01) and the Type 1 (4.77 +/- 0.48 versus 7.03 +/- 0.22 mg . min -1 . kg -1, p less than 0.01)diabetic patients. Insulin-stimulated glucose clearance was reduced to a similar extent in Type 2 (54%) and Type 1 (61%) diabetic subjects, and correlated directly with fasting glucose clearance. These results show that insulin resistance is a common feature of both types of diabetes and can be demonstrated in the basal as well as the insulin-stimulated state. Both hepatic and peripheral resistance to the action of insulin contribute to diabetic hyperglycaemia.

535 citations


Journal ArticleDOI
TL;DR: Following exercise, glucose transport and glycogen synthesis in skeletal muscle are enhanced due at least in part to an increase in insulin sensitivity, and it is suggested that this increase in diabetes sensitivity occurs predominantly in muscle fibers that are deglycogenated during exercise.
Abstract: Muscle glycogen stores are depleted during exercise and are rapidly repleted during the recovery period. To investigate the mechanism for this phenomenon, untrained male rats were run for 45 min on a motor-driven treadmill and the ability of their muscles to utilize glucose was then assessed during perfusion of their isolated hindquarters. Glucose utilization by the hindquarter was the same in exercised and control rats perfused in the absence of added insulin; however, when insulin (30-40,000 muU/ml) was added to the perfusate, glucose utilization was greater after exercise. Prior exercise lowered both, the concentration of insulin that half-maximally stimulated glucose utilization (exercise, 150 muU/ml; control, 480 muU/ml) and modestly increased its maximum effect. The increase in insulin sensitivity persisted for 4 h following exercise, but was not present after 24 h. The rate-limiting step in glucose utilization enhanced by prior exercise appeared to be glucose transport across the cell membrane, as in neither control nor exercised rats did free glucose accumulate in the muscle cell. Following exercise, the ability of insulin to stimulate the release of lactate into the perfusate was unaltered; however its ability to stimulate the incorporation of [(14)C]glucose into glycogen in certain muscles was enhanced. Thus at a concentration of 75 muU/ml insulin stimulated glycogen synthesis eightfold more in the fast-twitch red fibers of the red gastrocnemius than it did in the same muscle of nonexercised rats. In contrast, insulin only minimally increased glycogen synthesis in the fast-twitch white fibers of the gastrocnemius, which were not glycogen-depleted. The uptake of 2-deoxyglucose by these muscles followed a similar pattern suggesting that glucose transport was also differentially enhanced. Prior exercise did not enhance the ability of insulin to convert glycogen synthase from its glucose-6-phosphate-dependent (D) to its glucose-6-phosphate-independent (1) form. On the other hand, following exercise, insulin prevented a marked decrease in muscle glucose-6-phosphate, which could have diminished synthase activity in situ. The possibility that exercise enhanced the ability of insulin to convert glycogen synthase D to an intermediate form of the enzyme, more sensitive to glucose-6-phosphate, remains to be explored. These results suggest that following exercise, glucose transport and glycogen synthesis in skeletal muscle are enhanced due at least in part to an increase in insulin sensitivity. They also suggest that this increase in insulin sensitivity occurs predominantly in muscle fibers that are deglycogenated during exercise.

523 citations


Journal ArticleDOI
01 Aug 1982-Diabetes
TL;DR: The results indicate that increases in plasma growth hormone within the physiologic range can cause insulin resistance in man, which is due to decreases in both hepatic and extrahepatic effects of insulin.
Abstract: The present studies were undertaken to assess the mechanisms responsible for growth hormone-induced insulin resistance in man. The insulin dose-response characteristics for suppression of glucose production and stimulation of glucose utilization and their relationship to monocyte insulin binding were determined in six normal volunteers after 12-h infusion of growth hormone and 12-h infusion of saline. The infusion of growth hormone (2 micrograms . kg-1 . h-1) increased plasma growth hormone nearly threefold (to congruent to 9 ng/ml) within the range observed during sleep and exercise. This increased plasma insulin (14 +/- 1 versus 8 +/- 1 microunits/ml, P less than 0.005) concentrations without significantly altering plasma glucose concentrations or basal rates of glucose production and utilization. Insulin dose-response curves for both suppression of glucose production (half-maximal response at 37 +/- 3 versus 20 +/- 3 microunits/ml, P less than 0.01) and stimulation of glucose utilization (half-maximal response at 98 +/- 8 versus 52 +/- 8 microunits/ml, P less than 0.01) were shifted to the right with preservation of normal maximal responses to insulin. Monocyte insulin binding was unaffected. Thus, except at near maximal insulin receptor occupancy, the action of insulin on glucose production and utilization per number of monocyte insulin receptors occupied was decreased. These results indicate that increases in plasma growth hormone within the physiologic range can cause insulin resistance in man, which is due to decreases in both hepatic and extrahepatic effects of insulin. Assuming that insulin binding to monocytes reflects insulin binding in insulin sensitive tissues, this decrease in insulin action can be explained on the basis of a postreceptor defect.

452 citations


Journal ArticleDOI
01 Nov 1982-Diabetes
TL;DR: Results indicate a true saturation of the glucose oxidation pathway with pro-gressively increasing doses of insulin, and the glucose storage represents the major route of glucose disposal.
Abstract: The dose-response relationship between plasma insulin concentration and total glucose uptake, glucose oxidation, and glucose storage was examined in 22 healthy young volunteers by employing the euglycemic insulin clamp technique in combination with indirect calorimetry. Insulin was infused at five rates to achieve steady-state hyperinsulinemic plateaus of 62 ± 4, 103 ± 5, 170 ± 10, 423 ± 16, and 1132 ± 47 μU/ml. With increasing plasma insulin concentrations within the physiologic range, there was a linear increase in glucose uptake with a half maximally effective insulin concentration of 72 μU/ml. Glucose uptake by all tissues of the body reached 80% of its maximum value (12.6 mg/kg · min) at a plasma insulin concentration of ∼200 μU/ml. In contrast to total glucose uptake, glucose oxidation plateaued more quickly, achieved a maximum rate of only 4.0 mg/kg · min, and displayed a lower half maximally effective insulin concentration of 40 μU/ml. The increase in glucose uptake with progressively increasing plasma insulin levels was primarily the result of an increase in glucose storage, with a half maximally effective insulin concentration of 105 μU/ml and maximum rate of 8.7 mg/kg · min. Glucose storage represented over 60–70% of total glucose uptake at all insulin concentrations. After achieving maximum rates of insulin-mediated glucose uptake (plasma insulin concentration = 1132 μU/ml), hyperglycemia (+125 mg/dl) was superimposed on hyperinsulinemia to further enhance glucose transport. Under these conditions, total glucose uptake (32.5 mg/kg · min, P

443 citations


Journal ArticleDOI
TL;DR: Rat hepatoma cells were labeled with [32P]orthophosphate and the insulin receptor subunits were identified by immunoprecipitation and sodium dodecyl sulfate-acrylamide gel electrophoresis to suggest phosphorylation of the insulin receptors at multiple sites is an early event in insulin action.

Journal ArticleDOI
01 Sep 1982-Diabetes
TL;DR: The present results indicate that impaired insulin action is a common feature of insulin-dependent diabetics, despite daily insulin requirements that would not clinically characterize them as being insulin resistant.
Abstract: Tissue sensitivity to insulin was examined in 36 control subjects and 19 insulin-dependent diabetics with diabetes of long-standing duration (mean = 10 ± 3 yr) employing the insulin clamp technique (Δ plasma insulin concentration ∼100 βU/ml). Eleven of the diabetics (group I) were studied at their fasting hyperglycemic level (173 mg/dl); the remaining 8 diabetics (group II) were studied after lowering their plasma glucose concentration to euglycemic levels (90 mg/dl). Despite plasma glucose levels that were almost twice as great in the diabetics (group 1,173 versus 91 mg/dl, P < 0.001), insulin-mediated glucose metabolism, 4.77 ± 0.18 mg/kg · min, was reduced by 32% versus controls, 7.03 ± 0.22 mg/kg · min (P < 0.01). When the control subjects were restudied at plasma glucose levels (166 ± 2 mg/dl) that were comparable to those of the diabetics, insulin-mediated glucose metabolism was 12.14 ± 0.96 mg/kg · min (P < 0.01). In diabetics studied at euglycemic levels (group II) insulin-mediated glucose metabolism, 3.39 ± 0.30 mg/kg · min, was reduced even further. The metabolic clearance rate in the 19 diabetics, 3.31 ± 0.23 mg/kg · min, was reduced by 58% compared with controls, 7.83 / 0.25 (P < 0.001). These results emphasize the severe degree of insulin resistance that exists in the insulin-dependent diabetics. Basal hepatic glucose production in the diabetic group, 2.96 ± 0.24 mg/kg · min, was 26% greater than in the controls, 2.35 ± 0.04 (P < 0.001). The fasting plasma glucose concentration displayed a strong positive correlation (r = 0.857, P < 0.001) with basal hepatic glucose production and was weakly and inversely correlated (r = −0.413, P = 0.07) with the basal glucose clearance. Following hyperinsulinemia, however, suppression of hepatic glucose production was ∼ 9 5% in both diabetics and controls, suggesting that peripheral tissues are primarily responsible for the observed impairment in insulin-mediated glucose uptake. The present results indicate that impaired insulin action is a common feature of insulin-dependent diabetics, despite daily insulin requirements (35 ± 2 U/day) that would not clinically characterize them as being insulin resistant.

Journal ArticleDOI
L. J. Cianciola1, B.H. Park1, E. Bruck1, L. Mosovich1, Robert J. Genco1 
TL;DR: Because infections and inflammatory reactions often increase the insulin requirements of previously stable patients who have diabetes, this study of periodontal infections in young patients with insulin-dependent diabetes mellitus was undertaken.
Abstract: Because infections and inflammatory reactions often increase the insulin requirements of previously stable patients who have diabetes, this study of periodontal infections in young patients with insulin-dependent diabetes mellitus was undertaken.

Journal ArticleDOI
01 Apr 1982-Diabetes
TL;DR: Establishing increased metabolic efficiency in heterozygotes lends credence to the thrifty gene hypothesis of diabetes and suggests a mechanism whereby some deleterious diabetes genes may be favored in the human population.
Abstract: Several different rodent models are available for metabolic studies on the development of diabetes. Although the abnormalities associated with each diabetes type have many features in common, the documentation of several different genes being involved makes it unlikely that the various syndromes will be reduced to a single disturbance in one metabolic pathway. The severity of the diabetes produced depends on the interaction of the individual mutation with genetic factors in the inbred background of the host. Establishing the nature of these gene-host interactions in rodents should aid us in understanding similar interactions that occur in human diabetes. The development of the syndrome in most models is similar and includes hyperinsulinemia, hyperphagia, and attempts at increasing insulin supply by beta-cell hyperplasia and hypertrophy in the early stages. Hyperglycemia, obesity, and severe diabetes are secondary features that result from a combination of insulin resistance and a failure to sustain the secretion of the large amounts of insulin. Most models utilize ingested food and stored food reserves more efficiently. This increased metabolic efficiency extends to heterozygotes that are normal in all respects having only one dose of the deleterious gene. Establishing this increased metabolic efficiency in heterozygotes lends credence to the thrifty gene hypothesis of diabetes and suggests a mechanism whereby some deleterious diabetes genes may be favored in the human population. The best studied mouse models, and those for which the most complete information is available, are those caused by single genes, e.g., yellow, obese, diabetes, tubby, and fat. In the other models, the mode of inheritance is either polygenic or otherwise unclear, features which interfere with the interpretation of the data. This report briefly summarizes the developing syndrome in each model, points out any differences, and suggests the most appropriate areas where future research should be most productive in the light of contemporary studies.

Journal ArticleDOI
TL;DR: The maximal rate of glucose disposal is reduced in trauma patients; the metabolic clearance rate of insulin in the injured patients is almost twice normal and insulin resistance following injury appears to occur in peripheral tissues, probably skeletal muscle, and is consistent with a postreceptor defect.
Abstract: To assess the mechanisms of insulin resistance following injury, we examined the relationship between insulin levels and glucose disposal in nine nonseptic, multiple trauma patients (average age 32 years, Injury Severity Score 22) five to 13 days postinjury. Fourteen age-matched normals served as controls. Using a modification of the euglycemic insulin clamp technique, insulin was infused in 35 two-hour studies using at least one of four infusions rates (0.5, 1.0, 2.0 or 5.0 mU/kg min). Basal glucose levels were maintained by a variable infusion of 20% dextrose using bedside glucose monitoring and a servo-control algorithm. The amount of glucose infused reflected glucose disposal (M, mg/kg.min). Tracer doses of (6,6,2D2) glucose were administered in selected subjects to determine endogenous glucose production. At plasma insulin concentrations less than 100 microU/ml, responses in both groups were similar. However, maximal glucose disposal rates were significantly less in the patients than in the controls (9.17 +/- 0.87 mg/kg . min vs. 14.3 +/- 0.78, mean +/- SEM, p less than 0.01). Insulin clearance rates in the patients were almost twice that seen in controls. To further characterize this decrease in insulin responsiveness, we studied six additional patients and 12 controls following the acute elevation of glucose 125 mg/dl above basal (hyperglycemic glucose clamp). In spite of exaggerated endogenous insulin production in the patients (80-200 microU/ml vs. 30--70 in controls), M was significantly lower (6.23 +/- 0.59 vs. 9.46 +/- 0.79, p less than 0.02). In conclusion, this study demonstrated that (1) the maximal rate of glucose disposal is reduced in trauma patients; (2) the metabolic clearance rate of insulin in the injured patients is almost twice normal and; (3) insulin resistance following injury appears to occur in peripheral tissues, probably skeletal muscle, and is consistent with a postreceptor defect.

Journal ArticleDOI
01 Jan 1982-Diabetes
TL;DR: The data suggest that fetal malformations in the diabetic rat are attributable either to the hyperglycemia as such or to some accompanying metabolic consequence of insulin deficiency, and underscore the importance of a strict differentiation in the offspring of the diabetic rats between transient development retardations and true malformation.
Abstract: Intensive care of the pregnant mother with diabetes has dramatically decreased the incidence of diabetic fetopathy. The persistently high rate of fetal and neonatal mortality in diabetic pregnancies is nowadays mainly due to the increased incidence of serious congenital malformations. However, attempts to elucidate the precise teratogenic mechanisms have been sparse, presumably because of a lack of relevant animal models. In the present study we recorded the incidence and types of skeletal malformations in live offspring of normal rats and in rats made diabetic with the B-cytotoxic agent streptozotocin (SZ) at least 2 wk before conception. In some of the diabetic animals insulin treatment was begun 1 wk after the SZ injection and continued throughout pregnancy. In addition, the fetal development was followed by assessing the calcification of the skeleton on gestational days 20 and 22 with the aid of Alazarin Red S staining. Manifest diabetes in the pregnant rat induced a decrease in fetal weight and viability and marked retardation of skeletal maturation. In addition, about 20% of 135 viable fetuses showed skeletal malformations comprising either micrognathia or caudal dysgenesis. These defects were not found in 314 offspring of the control rats. Only two cases of caudal dysgenesis and none of micrognathia were detected among 233 offspring of the insulin-treated rats. The present data underscore the importance of a strict differentiation in the offspring of the diabetic rat between transient development retardations and true malformations. They also demonstrate that correction of the maternal glucose intolerance is crucial for preventing the fetus from developing skeletal malformations. Altogether the data suggest that fetal malformations in the diabetic rat are attributable either to the hyperglycemia as such or to some accompanying metabolic consequence of insulin deficiency.

Journal ArticleDOI
TL;DR: The euglycemic insulin and hyperglycemic clamp techniques were employed to examine the effect of physiological elevations in plasma GH concentrations on the tissue responses to insulin and on glucose-stimulated insulin secretion in young healthy volunteers.
Abstract: Pharmacological doses of GH are known to impair glucose tolerance. In the present study we have employed the euglycemic insulin and hyperglycemic clamp techniques to examine the effect of physiological elevations in plasma GH concentrations (27 ± 2 ng/ml) on the tissue responses to insulin and on glucose-stimulated insulin secretion. Three types of studies (low dose insulin clamp, high dose insulin clamp, and hyperglycemic clamp) were performed in young healthy volunteers before and after the infusion of GH (2 μg/kg-h) for 2 and 12 h. In the low dose insulin clamp studies, the plasma insulin concentration was acutely raised and was maintained at 59 ±4 μU/ml, while plasma glucose was maintained at basal levels. After 2 h of GH infusion, insulin-mediated glucose metabolism was slightly, although not significantly, decreased (4.48 ± 0.56 vs. 5.04 ± 0.39 mg/kg-min) in the control study. After 12 h of GH infusion, however, insulin-mediated glucose uptake decreased by 32 ± 9% (3.36 ± 0.40 mg/kg-min; P < 0.01). ...

Journal ArticleDOI
TL;DR: In intact subjects with the use of the euglycemic glucose clamp technique, both insulin receptors and insulin-mediated glucose metabolism have been studied in adipocytes and monocytes from affected individuals, and more severe insulin resistance is due to the postreceptor lesion and is correctable with appropriate therapy.
Abstract: Resistance to the action of insulin can result from a variety of causes, including the formation of abnormal insulin or proinsulin molecules, the presence of circulating antagonists to insulin or the insulin receptor, or defects in insulin action at the target tissue level. Defects of the latter type are characteristic of obesity and of noninsulin-dependent diabetes mellitus. Analysis of the nature of the insulin resistance in those disorders has been investigated in intact subjects with the use of the euglycemic glucose clamp technique, and both insulin receptors and insulin-mediated glucose metabolism have been studied in adipocytes and monocytes from affected individuals. In both conditions, the cause of insulin resistance is heterogeneous. In some, insulin resistance appears to be due to a defect in the insulin receptor, whereas others have a defect both in the receptor and at the postreceptor level. In both groups, more severe insulin resistance is due to the postreceptor lesion and is correctable with appropriate therapy.

Journal ArticleDOI
TL;DR: The results show that the vasomotor effects on regional flows are mediated both via adrenergic mechanisms, and in the case of skeletal muscle and kidney, via mechanisms unrelated to sympathetic stimulation.
Abstract: Cardiovascular actions of insulin were studied by intravenous infusions of insulin (4 and 8 mU/kg per min) in normal conscious dogs. This resulted in increases in cardiac output, heart rate, and left ventricular derivative of pressure with respect to time (dP/dt) and dP/dt/P, as blood glucose was reduced. The inotropic and chronotropic effects of insulin were not related to hypoglycemia, as they persisted even when blood glucose was restored to control values or when it was prevented from falling by a simultaneous infusion of glucose. These cardiac effects were accompanied by increases in plasma catecholamines, and were abolished by propranolol pretreatment. Both plasma epinephrine and norepinephrine increased during insulin hypoglycemia, but only norepinephrine increased during insulin infusion when euglycemia was maintained. Mean arterial blood pressure did not change significantly during insulin hypoglycemia, but rose if euglycemia was maintained, probably due to the selective increase in norepinephrine in the latter condition. A pressor response also occurred in propranolol-pretreated dogs during insulin hypoglycemia, but was abolished when the animals also had been pretreated with phentolamine, indicating that the vasoconstrictor action of insulin was mediated via alpha adrenergic receptors. Insulin infusion increased left ventricular work and myocardial blood flow in dogs with and without hypoglycemia. Myocardial blood flow, however, did not change significantly during insulin infusion in dogs pretreated with propranolol. As propranolol also diminished the inotropic response, it appears that the increase in myocardial blood flow caused by insulin in the normal dog is causally related to the increased myocardial metabolic demand. Insulin also produced vasomotor effects on other vascular beds. In skeletal muscle, blood flow was increased under all study conditions, except during insulin hypoglycemia after propranolol-pretreatment when unopposed alpha-mediated vasoconstriction was present. The persistent increase in flow during both alpha and beta adrenergic blockade suggests that insulin has a direct dilator effect on skeletal muscle vasculature. In the adrenal gland, flow was increased except during euglycemia, when no rise in plasma epinephrine was observed, suggesting coupling between adrenal flow and catecholamine release. In the splanchnic bed, flow was decreased during euglycemia, when plasma norepinephrine rose, and during beta adrenergic blockade with propranolol, when unopposed alpha-mediated vasoconstriction also predominated. A similar pattern was found in the kidney, except that renal blood flow also fell after combined alpha and beta adrenergic blockade. The results show that the vasomotor effects on regional flows are mediated both via adrenergic mechanisms, and in the case of skeletal muscle and kidney, via mechanisms unrelated to sympathetic stimulation.

Journal ArticleDOI
TL;DR: The inverse relationship between insulin-stimulated adipose tissue lipoprotein lipase activity and basal enzyme activity suggests that adipose tissues itself is the main regulator of the lipase response to insulin.
Abstract: The role of insulin in the regulation of adipose tissue lipoprotein lipase activity in humans was investigated in 11 normal subjects and compared with the effects of 0.9% saline infusions in five control subjects. After a basal adipose tissue biopsy for lipoprotein lipase activity, insulin was rapidly infused to achieve and maintain serum levels of approximately 70 microunits/ml while plasma glucose was kept at basal concentrations. Free fatty acids in serum fell to 27 +/- 3% of basal by 20 min (t = 5.19, P less than 0.001) and triglycerides decreased to 77 +/- 3% of basal by 80 min (t = 3.76, P less than 0.01). Adipose tissue lipoprotein lipase activity failed to increase significantly above that measured in controls by the first 3 h of the study. By 6 h of the infusion a stimulatory effect of insulin on adipose tissue lipoprotein lipase was found (t = 3.94, P less than 0.01). There was no relationship between the amount of glucose infused and the insulin effect on the enzyme. The increase in adipose tissue lipoprotein lipase activity at 6 h, however, was inversely related to the basal lipase activity (r = -0.690, P less than 0.02). Thus, insulin appears to stimulate adipose tissue lipoprotein lipase activity in humans. This effect of insulin is delayed when compared with antilipolysis and the fall in plasma triglyceride. The inverse relationship between insulin-stimulated adipose tissue lipoprotein lipase activity and basal enzyme activity suggests that adipose tissue itself is the main regulator of the lipase response to insulin.

Journal ArticleDOI
TL;DR: Findings have clinical significance and should not be without potential benefit in the attempt to improve metabolic control in insulin-treated diabetic patients.
Abstract: This paper describes systematic studies on the absorption kinetics of exogenous insulin from its subcutaneous tissue depot in 52 male nonobese volunteers (age 20-30 yr). Five experimental protocols were used: effect of changing injection site, effect of temperature change and local massage, effect of aprotinin and human serum, effect of mixing regular insulin with long-acting insulin preparations, and effect of temperature change, muscular exercise, and local massage on the absorption of long-acting insulin preparations. The fastest absorption of insulin occurred at the abdominal injection. Absorption after arm injection was faster than after thigh injection. A hot bath and local massage dramatically increased serum insulin levels in the first 90 min after injection; in contrast, a cold bath delayed absorption substantially. Both aprotinin and the subjects' own blood serum mixed with insulin caused a marked acceleration of the insulin absorption process. Absorption kinetics of two neutral regular insulins (Actrapid and Leo Regular) were virtually identical. Mixing Actrapid with Monotard caused higher serum insulin levels than the mixture of Leo Regular with NPH. A time lag of 5 min between the mixing of Actrapid and Monotard and the injection caused a delayed rise of serum insulin levels; in contrast, this delay could not be observed when Leo Regular and NPH were mixed. Volunteers performed bicycle exercise, applied a hot water bottle to the injection site, or rubbed the injection site 2 1/2 h after injection of long-acting insulin. Accelerated absorption of insulin was only observed after local massage of the injection site of Monotard, Leo NPH, and Mixtard. Local heat had no effect. Exercise caused only an increased absorption of insulin after the Mixtard injection but not after Monotard or NPH injection. These findings have clinical significance and should not be without potential benefit in the attempt to improve metabolic control in insulin-treated diabetic patients.

Journal ArticleDOI
TL;DR: The postreceptor defect in insulin-stimulated glucose disposal is largely ameliorated by exogenous insulin treatment, suggesting that this defects in insulin action is an acquired abnormality which is secondary to some aspect of the insulin-deficient state.
Abstract: Type II diabetic subjects are both insulin-deficient and insulin-resistant. Recent studies suggest that the insulin resistance is due to a combined receptor and postreceptor defect with the postreceptor defect being the predominant lesion. In the present study, we examined the effects of exogenous insulin therapy upon these defects in insulin action in six untreated type II diabetic subjects. Glycemic control and adipocyte insulin binding were measured and in vivo insulin dose-response curves for overall glucose disposal and suppression of hepatic glucose output were constructed before treatment. Following these initial studies, the diabetic subjects were treated with twice-daily injections of regular and NPH purified pork insulin for 14 days and the pretreatment studies repeated. Glycemic control was significantly improved by this treatment regimen. The mean fasting serum glucose level (±SE) fell from 287 ± 20 to 125 ± 13 mg/dl, the mean glycosylated hemoglobin level (± SE) decreased from 14.2 ± 1.1% to 8.3 ± 0.5%, and the mean 24-h urinary glucose excretion (±SE) declined from 65.6 ± 40.3 to 0.6 ± 0. 1 g/24 h. Adipocyte insulin binding did not change significantly during the treatment period. In contrast, the 14-day period of insulin treatment produced a 72% increase (P 2 /min compared with 187 ± 32 mg/M 2 /min before treatment, indicating that the postreceptor defect in insulin action was significantly ameliorated by insulin treatment. The dose-response curve for insulin-mediated suppression of hepatic glucose output was rightshifted, consistent with the decrease in insulin binding, with no decrease in the maximal effect before treatment and not significantly changed following insulin treatment. In conclusion, the postreceptor defect in insulin-stimulated glucose disposal is largely ameliorated by exogenous insulin treatment, suggesting that this defect in insulin action is an acquired abnormality which is secondary to some aspect of the insulin-deficient state.

Journal ArticleDOI
TL;DR: This study provides direct support for the concept that the microanatomy of the islet creates the anatomical basis for functional cooperation between islet cells and hence for an appropriate glucose-induced insulin release.
Abstract: Similar to other endocrine glands, the endocrine pancreas displays a characteristic topography of its constituent cells. The functional significance of this structural organization was examined by measuring the secretory activity of the B cell in rat islet cell preparations of different composition. Glucose released 30-fold more insulin from B cells lodged within intact islets as from purified single B cells; structurally coupled B cells and single B cells isolated with A cells or incubated with glucagon responded 4- and 2-fold, respectively, more effectively to glucose than single B cells alone. Glucose homeostasis is thus dependent not only on the number and integrity of the insulin-containing B cells but also on their interactions with neighboring B and non-B cells. This study provides direct support for the concept that the microanatomy of the islet creates the anatomical basis for functional cooperation between islet cells and hence for an appropriate glucose-induced insulin release.

Journal ArticleDOI
TL;DR: Marked lymphopenia, mainly of thymus-derived (T) lymphocytes, both precedes and is sustained during glucose intolerance and overt diabetes, and appears to be associated reliably with insulitis, and may be a simple marker of susceptibility thereto.
Abstract: The diabetes which occurs spontaneously in the ‘BB’ Wistar rat has many affinities with human Type 1 (insulin-dependent) diabetes. It occurs in a non-obese, standard, laboratory rat derived from a non-inbred Wistar line. Both sexes are affected, with onset corresponding approximately to the time of sexual maturation. Both genetic and immune factors are involved in the aetiology, but their precise nature remains to be defined. Evolution of the overt clinical syndrome occurs over a period of hours to a few days. An intense insulitis is found, accompanied by selective destruction of B cells. Although insulitis may precede diabetes by many weeks, within 7–21 days after glycosuria the B cells are completely destroyed and have disappeared and the islets are few, small and with little residual inflammation. If untreated, marked wasting of body tissues, including fat and muscle protein, dehydration, and ketosis supervene. Careful study of littermates reveals glucose intolerance in 10%–25%, accompanied always by insulitis and these rats may subsequently develop insulin-dependent diabetes. Marked lymphopenia, mainly of thymus-derived (T) lymphocytes, both precedes and is sustained during glucose intolerance and overt diabetes. This lymphopenia appears to be associated reliably with insulitis, and may be a simple marker of susceptibility thereto. Abnormalities of nerves, testicles, and a tendency towards increased frequency of lymphomas have been found. Further research in this animal could lead to insights into aetiology, pathophysiology and complications potentially applicable to man.

Journal Article
TL;DR: An appreciation of the physiology of fasting is essential to the understanding of therapeutic dietary interventions and the effect of food deprivation in various diseases.
Abstract: An appreciation of the physiology of fasting is essential to the understanding of therapeutic dietary interventions and the effect of food deprivation in various diseases. The practice of prolonged fasting for political or religious purposes is increasing, and a physician is likely to encounter such circumstances. Early in fasting weight loss is rapid, averaging 0.9 kg per day during the first week and slowing to 0.3 kg per day by the third week; early rapid weight loss is primarily due to negative sodium balance. Metabolically, early fasting is characterized by a high rate of gluconeogenesis with amino acids as the primary substrates. As fasting continues, progressive ketosis develops due to the mobilization and oxidation of fatty acids. As ketone levels rise they replace glucose as the primary energy source in the central nervous system, thereby decreasing the need for gluconeogenesis and sparing protein catabolism. Several hormonal changes occur during fasting, including a fall in insulin and T(3) levels and a rise in glucagon and reverse T(3) levels. Most studies of fasting have used obese persons and results may not always apply to lean persons. Medical complications seen in fasting include gout and urate nephrolithiasis, postural hypotension and cardiac arrhythmias.

Journal ArticleDOI
TL;DR: In detergent-solubilized membrane extracts, insulin stimulates the phosphorylation of its own receptor on tyrosine residues, which has enzymatic properties distinct from those of the EGF-stimulatedosphorylation in these same extracts.

Journal ArticleDOI
TL;DR: Positive short-loop insulin-beta-cell feedback was operative in both the lean and obese states, and despite this suppression, the insulin-secretion rate in obese subjects was still greater than that in non-obese subjects.
Abstract: We investigated the possible existence of a negative short-loop feedback of circulating insulin on the parent beta cell in 10 lean Caucasians, 10 obese Caucasians, and 10 obese Pima Indians. Plasma insulin levels were raised acutely by 100 microunits per milliliter for 90 minutes, and plasma glucose was maintained by the "clamp" technique. C-peptide levels were suppressed in all groups to approximately 50 per cent of basal values. However, the obese groups had absolute C-peptide levels much higher than those of the lean group. During the hour after infusion, the rate and magnitude of C-peptide recovery in the obese groups were higher than in the lean group. Thus, negative short-loop insulin-beta-cell feedback was operative in both the lean and obese states. Despite this suppression, the insulin-secretion rate in obese subjects was still greater than that in non-obese subjects. Inadequate feedback suppression may account in part for the prevailing hyperinsulinemia of the obese.

Journal ArticleDOI
TL;DR: It is proposed as a working hypothesis that translocation of the glucose transport system to the plasma membrane from the Golgi-rich fraction is the major, if not the sole, mechanism by which insulin stimulates glucose transport in fat cells.

Journal ArticleDOI
TL;DR: The results suggest that chronic hyperglycemia decreases the number of hexose carrier molecules available at the blood-brain barrier, which may explain the abnormal sensitivity to abrupt blood glucose lowering in patients with diabetes mellitus.
Abstract: We used the Oldendorf brain uptake index method to study the blood-brain barrier transport of several metabolic substrates in diabetes. Glucose transport into the brain was decreased by 1/3 in rats with moderate diabetes induced by prior injection of streptozotocin (65 mg/kg of body weight). The transports of mannose and the poorly metabolized hexoses 2-deoxyglucose and 3-O-methylglucose were similarly reduced. Likewise, brain glucose transport was decreased in rats with alloxan-induced diabetes. These alterations in brain hexose influx appeared to be related to chronic (1-2 days) hyperglycemia rather than to insulin-lack per se. Thus, starvation of the diabetic rats for 48 hr restored both the plasma glucose concentration and brain hexose transport to normal. Conversely, the substitution of 10% sucrose for their drinking water both increased plasma glucose and decreased hexose transport in insulin-treated diabetic rats. The 45% decrease in maximal glucose transport rate observed and the uniformity of diminished hexose transport probably imply a decrease in the number of available high-affinity transport carriers at the blood-brain barrier. This defect was specific for hexoses in that the transports of neutral and basic amino acids and of beta-hydroxybutyrate were not similarly affected. These results suggest that chronic hyperglycemia decreases the number of hexose carrier molecules available at the blood-brain barrier. Such an adaptation could operate to decrease the net flux of glucose into the brain during sustained hyperglycemia. It also may explain the abnormal sensitivity to abrupt blood glucose lowering in patients with diabetes mellitus.

Journal ArticleDOI
TL;DR: The observed effects of insulin occurred at concentrations close to the physiological range and suggest that the direct hepatic effect is to suppress VLDL secretion although the net effect in vivo will clearly reflect many additional accompanying changes.
Abstract: The effect of insulin on hepatic triglyceride synthesis and secretion is controversial. Previously, we have described a cell culture system of adult rat hepatocytes that synthesize and secrete very low density lipoprotein (VLDL) triglycerides with small and irreproducible effects of insulin on triglyceride metabolism. To study the primary effects of insulin on hepatic triglyceride metabolism a method was developed utilizing fibronectin-coated culture dishes that allowed adhesion, spreading, and maintenance of hepatocytes for 2-3 d in the absence of serum and insulin. This culture system allowed mass measurements of both cellular and secreted VLDL triglycerides for long time periods after the addition of physiological concentrations of insulin to hormone-free culture medium. In the absence of insulin and after an initial 4 h in culture, the medium was replenished and triglyceride mass was measured at the end of 18-h incubations. VLDL triglyceride accumulated in the culture medium at a linear rate over this time-course with increasing accumulation as the medium glucose concentration was raised from 2.5 to 25 mM glucose (1.77+/-0.24 to 3.09+/-0.76 mug triglyceride/mg cell protein per h). There was no apparent significant lipolysis or hepatocellular reuptake of secreted VLDL triglycerides. In the absence of insulin cellular triglyceride levels were unchanged between 3 and 24 h in culture while insulin (50-500 muU/ml) significantly increased cellular triglyceride content at all glucose concentrations tested (0-25 mM). The addition of insulin to the culture medium progressively reduced the rate of VLDL triglyceride secretion accompanied by an increase in cellular triglyceride at insulin concentrations > 50 muU/ml. Most or all of the observed increase in cell triglyceride content could in all experiments be accounted for by the insulin-induced inhibition of VLDL secretion. Incorporation of [2-(3)H]glycerol into cellular and VLDL triglycerides as a function of insulin concentration was also measured. Glycerol incorporation data at 20-22 h after plating of the cells closely paralleled the insulin-induced changes in cellular and VLDL triglyceride as determined by mass analysis. The observed effects of insulin occurred at concentrations close to the physiological range and suggest that the direct hepatic effect is to suppress VLDL secretion although the net effect in vivo will clearly reflect many additional accompanying changes.