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Diabetologia

, Volume 37, Issue 10, pp 1025–1035 | Cite as

Effect of sustained physiologic hyperinsulinaemia and hyperglycaemia on insulin secretion and insulin sensitivity in man

  • S. Del Prato
  • F. Leonetti
  • D. C. Simonson
  • P. Sheehan
  • M. Matsuda
  • R. A. DeFronzo
Originals

Summary

Two study protocols to examine the effects of chronic (72–96 h) physiologic euglycaemic hyperinsulinaemia (+ 72 pmol/l) and chronic hyperglycaemic (+ 1.4 mmol/l) hyperinsulinaemia (+ 78 pmol/l) on insulin sensitivity and insulin secretion were performed in 15 healthy young subjects. Subjects received a three-step euglycaemic insulin (insulin infusion rates = 1.5, 3, and 6 nmol·kg−1·min−1) clamp and a hyperglycaemia (6.9 mmol/l) clamp before and after chronic insulin or glucose infusion. Following 4 days of sustained euglycaemic hyperinsulinaemia whole body glucose disposal decreased by 20–40%. During each insulin clamp step, the defect in insulin action was accounted for by impaired non-oxidative glucose disposal (p<0.01). Chronic euglycaemic hyperinsulinaemia did not alter insulin-mediated suppression of hepatic glucose production. Following insulin infusion the ability of hyperglycaemia to stimulate insulin secretion was significantly diminished. Following 72 h of chronic glucose infusion (combined hyperglycaemic hyperinsulinaemia), there was no change in whole body glucose disposal. However, glucose oxidation during each insulin clamp step was significantly increased and there was a reciprocal decline in non-oxidative glucose disposal by 25–39% (p<0.01); suppression of hepatic glucose production by insulin was unaltered by chronic hyperglycaemic hyperinsulinaemia. Chronic glucose infusion increased the plasma insulin response to acute hyperglycaemia more than twofold. These results demonstrate that chronic, physiologic hyperinsulinaemia, whether created by exogenous insulin infusion or by stimulation of endogenous insulin secretion, leads to the development of insulin resistance, which is characterized by a specific defect in the non-oxidative (glycogen synthetic) pathway. These findings indicate that hyperinsulinaemia should be considered, not only as a compensatory response to insulin resistance, but also as a self-perpetuating cause of the defect in insulin action.

Key words

Chronic hyperinsulinaemia chronic hyperglycaemia insulin resistance insulin secretion impaired glycogen synthesis 

Abbreviations

NIDDM

Non-insulin-dependent diabetes mellitus

CRC

Clinical Research Center

Rd

rate of glucose disappearance

Ra

rate of glucose appearance

HGP

hepatic glucose production

NPRQ

non-protein respiratory quotient

CV

coefficient of variation

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Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • S. Del Prato
    • 2
  • F. Leonetti
    • 1
  • D. C. Simonson
    • 3
  • P. Sheehan
    • 1
  • M. Matsuda
    • 1
  • R. A. DeFronzo
    • 1
  1. 1.Diabetes DivisionUniversity of Texas Health Science Center and Audie L. Murphy VA HospitalSan AntonioUSA
  2. 2.Cattedra di Malattie del RicambioUniversity of PadovaPadovaItaly
  3. 3.Joslin Diabetes CenterBrigham and Women's Hospital and Harvard Medical SchoolBostonUSA

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