Search PubMed⌕ Search

Biomedical subjects

J E Gerich

Publications and source records attributed to J E Gerich.

At least 163 records · Page 9Linked to original sources
PubMed1981

Dose-response characteristics for effects of insulin on production and utilization of glucose in man.

To determine the dose-response characteristics for the effects of insulin on glucose production, glucose utilization, and overall glucose metabolism in normal man, 15 healthy subjects were infused with insulin for 8 h at sequential rates ranging from 0.2 to 5.0 mU.kg-1.min-1; each rate was used for 2 h. Glucose production and utilization were measured isotopically ([3-3H]glucose). Tissue insulin receptor occupancy was estimated from erythrocyte insulin binding. Glucose production was completely suppressed at plasma insulin concentrations of approximately 60 microunits/ml. Maximal glucose utilization (10-11 mg.kg-1.min-1) occurred at insulin concentrations of 200-700 microunits/ml. The concentration of insulin causing half-maximal glucose utilization (55 + 7 microunits/ml) was significantly greater than that required for half-maximal suppression of glucose production (29 +/- 2 microunits/ml, P less than 0.01). Maximal effects of insulin on glucose production and utilization occurred at plasma insulin concentrations causing 11 and 49% insulin receptor occupancy, respectively. The above dose-response relationships indicate that in man 1) glucose production is more sensitive to changes in plasma insulin concentration than is glucose utilization; 2) both hepatic and peripheral tissues may contain "spare" insulin receptors; and 3) relatively minor changes in plasma insulin concentration or insulin receptor function can cause appreciable alterations in glucose metabolism.

Adolescent↗
PubMed1981

Suppression of glucose production and stimulation of insulin secretion by physiological concentrations of ketone bodies in man.

To determine the mechanism by which ketone bodies decrease plasma glucose in man, seven normal postabsorptive volunteers were infused for 3 h with beta-hydroxybutyrate. Total plasma ketone bodies (beta-hydroxybutyrate plus acetoacetate) increased to levels (approximately 2.5 mM) observed after a 2- to 3-day fast in normal subjects. Plasma glucose decreased 10% concomitant with decreases of 25% and 10%, respectively, in the rates of glucose production and glucose utilization determined isotopically with [3-3H]glucose. Plasma insulin and glucagon concentrations were unaltered, but plasma C-peptide levels increased from 2.6 +/- 0.1 ng/ml to a maximum of 3.9 +/- 0.2 ng/ml at 30 min (P < 0.01) and remained significantly increased for more than 2 h. Plasma alanine decreased approximately 14% (P < 0.05), while plasma lactate increased 25% (P < 0.01) so that there was no net decrease in the combined levels of these gluconeogenic substrates. These results demonstrate that physiological increments in circulating ketone body concentrations decrease plasma glucose in normal man by suppressing glucose production, an effect which can be explained by the stimulation of insulin secretion being reflected only in changes in plasma C-peptide. Thus, changes in pancreatic B cell function not sufficient to alter peripheral plasma insulin levels may cause significant changes in hepatic glucose production.

Adult↗
PubMed1981

Physiological concentrations of growth hormone exert insulin-like and insulin antagonistic effects on both hepatic and extrahepatic tissues in man.

To determine whether increments in circulating GH concentrations within the physiological range would exert insulin-like as well as insulin-antagonistic actions in man and, if so, whether both actions would occur in hepatic and extrahepatic tissues, normal volunteers (n = 6) were infused with human GH (hGH; 100 ng/kg . min) for 6 h along with somatostatin (100 micrograms/h) to suppress insulin, glucagon, and hGH secretion and also with sufficient insulin (100 microU/kg . min) to maintain a constant plasma insulin level. During the final 2 h, glucose (2 mg/kg . min) was infused. In control studies, saline was infused instead of hGH. Infusion of hGH increased plasma hGH to 35 ng/ml. Plasma glucose decreased to 60 +/- 2 mg/dl compared to 67 +/- 1 mg/dl observed in control studies (P less than 0.05); this greater hypoglycemia was due to both greater suppression of hepatic glucose production (P less than 0.05) and greater augmentation of glucose clearance (P less than 0.05). These insulin-like effects of hGH were no longer evident after 2 h. Subsequently, when glucose was infused, plasma glucose increased to 133 +/- 4 mg/dl compared to the 104 +/- 6 mg/dl observed in control studies (P less than 0.01). This greater hyperglycemia was due to both impaired suppression of hepatic glucose production (P less than 0.001) and decreased glucose clearance (P less than 0.01). These results indicate that physiological increments in plasma hGH cause both insulin-like and insulin-antagonistic effects in man and that these actions occur in hepatic as well as extrahepatic tissues. The insulin-like actions of hGH are transient.

Adult↗
PubMed1981

Mechanism and significance of insulin resistance in non-insulin-dependent diabetes mellitus.

To determine whether receptor and/or postreceptor abnormalities of insulin action were responsible for insulin resistance in nonobese patients with non-insulin-dependent diabetes mellitus (NIDDM) and to assess the role of insulin resistance in their impaired glucose tolerance, insulin dose-response characteristics, insulin binding to monocytes, and insulin secretion were compared in 10 nonobese patients with NIDDM and six age-weight-matched nondiabetic volunteers. The insulin resistance of the diabetics was characterized by a shift to the right of their insulin dose-response curve (Km 81 +/- 4 microunits/ml vs. 58 +/- 2 microunits/ml in the nondiabetics P less than 0.001) but a normal maximal response to insulin. Although monocyte insulin binding was decreased in the diabetics (P less than 0.01), their response to insulin was appropriate for the number of insulin receptors occupied indicating normal postreceptor function. Insulin secretion was markedly reduced in diabetic subjects (52 +/- 22 vs. 471 +/- 90 microunits . ml-1 . 10 min-1 in the nondiabetic subjects, P less than 0.001) and was more strongly correlated with fasting plasma glucose (r = 0.92, P less than 0.001) and intravenous glucose tolerance (Kivgtt) (r = 0.98, P less than 0.001) than was insulin sensitivity (Km) (r = 0.23, NS, and r = 0.57, P less than 0.05, respectively). We conclude that in nonobese patients with NIDDM, insulin resistance is characterized by a shift to the right of the insulin dose-response curve, which can be accounted for solely by an insulin receptor defect. However, in these patients, impaired insulin secretion rather than insulin resistance appears to be the predominant metabolic abnormality.

Aged↗
PubMed1981

Pathogenesis of hypoglycemia in insulinoma patients: suppression of hepatic glucose production by insulin.

To determine the mechanism by which hyperinsulinemia causes hypoglycemia in insulinoma patients, rates of glucose production and utilization, and circulating levels of insulin, glucagon, alanine, lactate, and glycerol were measured in 6 insulinoma patients during development of fasting hypoglycemia and in 8 normal volunteers studied over an identical interval. Initially, insulinoma patients had a greater plasma insulin (42 +/- 9 versus 15 +/- 1 microunits/ml) and glucagon levels (214 +/- 31 versus 158 +/- 21 pg/ml) than normal subjects, P less than 0.05, but their plasma glucose levels (81 +/- 4 mg/dl) and rates of glucose production and utilization (1.71 +/- 0.08 and 1.74 +/- 0.08 mg/kg . min, respectively) were not significantly different from those of normal subjects (93 +/- 2 mg/dl, 1.93 +/- 0.11, and 1.92 +/- 0.13 mg/kg . min, respectively). During a subsequent 8-h fast, glucose production and glucose utilization decreased in both groups, but more markedly in insulinoma patients. Since glucose utilization exceeded glucose production to a greater extent in insulinoma patients than in normal subjects, plasma glucose decreased to 44 +/- 3 mg/dl in insulinoma patients, but only to 84 +/- 1 mg/dl in normal subjects (P less than 0.001). Glucose utilization in insulinoma patients never exceeded that of normal subjects. These results demonstrate that fasting hypoglycemia in the insulinoma patients is usually due to suppression of glucose production rather than to acceleration of glucose utilization, as is widely thought. A direct effect of insulin on the liver is probably responsible, since circulating levels of gluconeogenic precursors are normal and since plasma glucagon increases during development of hypoglycemia in insulinoma patients.

Adenoma, Islet Cell↗
PubMed1981

Effects of plasma glucose concentration on glucose utilization and glucose clearance in normal man.

Glucose clearance (glucose utilization divided by plasma glucose) is commonly used to assess glucose utilization under conditions in which plasma glucose concentrations vary. The validity of this practice requires that glucose clearance itself be independent of plasma glucose concentration. The present studies were, therefore, undertaken to determine the relationship between glucose clearance and plasma glucose concentration in man. Using the glucose clamp technique, rates of glucose utilization (measured isotopically with 3-3H-glucose) and glucose clearance were determined in 5 normal volunteers at steady-state plasma glucose concentrations of approximately 60, 95, 130, and 165 mg/dl, while plasma insulin concentrations were maintained constant (approximately 18 microU/ml) by infusion of insulin and somatostatin. Despite virtually identical 0.4 mg X kg-1 X min-1 increments in glucose utilization for each 35-mg/dl increment in plasma glucose, glucose clearance decreased as a function of plasma glucose concentration (r = -0.85, P less than 0.001). These results indicate that glucose clearance is not independent of changes in plasma glucose concentration and, thus, use of glucose clearance to evaluate glucose utilization of differing plasma glucose concentration is not valid. Whether this conclusion also applies to similar use of clearance for other substrates remains to be determined.

Adult↗
PubMed1981

Effect of peripheral versus portal venous administration of insulin on postprandial hyperglycemia and glucose turnover in alloxan-diabetic dogs.

The effects of peripheral venous and portal venous delivery of insulin by a closed-loop insulin infusion device (Biostator GCIIS) on postprandial hyperglycemia and rates of glucose appearance, disappearance, and clearance were compared in alloxan-diabetic dogs. The amounts of insulin required and the peripheral venous plasma insulin concentrations achieved were not different for the two routes of insulin administration. No statistically significant differences in postprandial hyperglycemia or patterns of glucose disposal were observed between the two routes of insulin delivery. These studies indicate that in terms of hepatic versus extrahepatic disposal of glucose, there appears to be no practical advantage of portal venous over peripheral venous administration of insulin when a closed-loop insulin infusion device is used.

Alloxan↗
PubMed1981

Physiology of glucagon.

Recent evidence indicates that glucagon is important in the physiological regulation of hepatic glucose and ketone body metabolism. It is the major acute glucocounterregulatory hormone in man and is one of several hormones with actions antagonistic to those of insulin that can exacerbate the metabolic consequences of insulin deficiency. The secretion of glucagon is governed by both local (e.g., somatostatin) and systemic factors (e.g., substrates and catecholamines), the most important of which is the plasma glucose concentration. Plasma glucagon immunoreactivity is heterogeneous, and only a minor portion is biologically active-an important consideration in the interpretation of results based on radioimmunoassay data. The liver and kidney are primarily responsible for the catabolism of glucagon. Consequently, peripheral venous glucagon concentrations may not necessarily reflect concentrations of glucagon delivered to its target organ, the liver, via the portal vein. Liver and renal disease may increase circulating plasma glucagon concentrations and alter the composition of plasma glucagon immunoreactivity. A cell function is abnormal in human diabetes and is characterized by relative or absolute fasting hyperglucagonemia, excessive increases in plasma glucagon following meals, and lack of appropriate responses to changes in plasma glucose concentrations. The exact extend to which these abnormalities are the result of insulin deficiency and an intrinsic A cell defect remains to be determined. A cell dysfunction contributes to the fasting hyperglycemia and hyperketonemia in diabetes and probably also to postprandial hyperglycemia. Of all the hormones antagonistic to insulin, glucagon seems to be the most important in exacerbating the metabolic consequences of insulin deficiency.

Animals↗
PubMed1980

Control of blood sugar in insulin-dependent diabetes: comparison of an artificial endocrine pancreas, continuous subcutaneous insulin infusion, and intensified conventional insulin therapy.

We compared the ability of closed-loop intravenous insulin infusion (i.e., an artificial "pancreas"), open-loop continuous subcutaneous insulin infusion, and intensified conventional insulin therapy (preprandial injections of regular insulin, with injection of long-acting zinc-suspension insulin before breakfast) to bring the hyperglycemia of insulin-dependent diabetic subjects to a level comparable to that of normal, nondiabetic subjects. The mean circadian levels of plasma glucose, mean amplitude of glycemic excursions, and M values (defined in Methods) did not significantly differ among the three regimens. Although these levels in the diabetic subjects approximated those in the normal subjects, the levels of plasma insulin, mean amplitude of glycemic excursions, and M values were significantly higher than those in normal subjects (P < 0.01). Therefore, at least on a short-term basis, all three regimens can produce comparable, nearly normal levels of blood sugar in such patients; moreover, closed-loop devices can be used to determine insulin requirements for conventional therapy.

Adult↗
PubMed1980

Determination of leucine flux in vivo by gas chromatography-mass spectrometry utilizing stable isotopes for trace and internal standard.

A simple and reliable method is described for the determination of leucine flux in vivo using two stable isotopes of leucine and gas chromatography-mass spectrometry (GC-MS). [6,6,6-2H3]Leucine is administered as a primed-dose constant infusion in vivo and DL-[2H7]-leucine is added to plasma as an internal standard. Plasma leucine concentration and moles per cent enrichment of [2H3]leucine can be determined simultaneously by GC-MS and selected ion monitoring. Leucine flux calculated from the [6,6,6-2H3]leucine data was nearly identical to that obtained with L-[U-14C]leucine in dogs. This method is readily applicable to the study of leucine metabolism in humans of all ages and laboratory animals.

Animals↗
PubMed1980

Epinephrine and norepinephrine are cleared through beta-adrenergic, but not alpha-adrenergic, mechanisms in man.

Although catecholamines are rapidly removed from the extracellular fluid, the role of adrenergic mechanisms in the clearance of epinephrine and norepinephrine has not been defined. In five normal human subjects, mean (+/- SE) plasma epinephrine concentrations did not change during control infusions, rose from 21 +/- 6 pg/ml to 834 +/- 84 pg/ml during the infusion of epinephrine (50 ng/kg/min) over 180 min and to 853 +/- 112 pg/ml during the infusion of epinephrine plus phentolamine (500 micrograms/min after a 5.0 mg loading dose infused over 2 min), but to 2400 +/- 104 pg/ml during the infusion of epinephrine plus propranolol (80 micrograms/min after a 5.0 mg loading dose infused over 2 min), indicating that beta-adrenergic blockade sharply reduces the clearance of epinephrine in man. In separate studies in seven subjects, similar increments in plasma epinephrine occurred during the infusion of epinephrine alone and the clearance of epinephrine was comparably reduced during the infusion of epinephrine plus propranolol and during the infusion of epinephrine plus propranolol plus phentolamine, suggesting that the reduction of epinephrine clearance produced by beta-adrenergic blockade during epinephrine infusion is not mediated by an alpha-adrenergic reduction of blood flow to organs of epinephrine clearance. Endogenous plasma norepinephrine concentrations doubled during the infusion of phentolamine without propranolol but rose to nearly fourfold higher values during the infusion of phentolamine with propranolol indicating that beta-adrenergic blockade reduces the clearance of norepinephrine as well as that of epinephrine. These findings indicate that epinephrine and norepinephrine are cleared through beta-adrenergic, but not alpha-adrenergic, mechanisms in man.

Adrenergic alpha-Antagonists↗
PubMed1980

Adrenergic mechanisms of catecholamine action on glucose homeostasis in man.

To assess the adrenergic mechanisms responsible for the effect of epinephrine on glucose production and glucose clearance in man, epinephrine (50 ng/kg/min) was infused in the presence and absence of alpha adrenergic (phentolamine) and beta adrenergic (propranolol) antagonists under conditions when plasma glucose, insulin, and glucagon levels were allowed to vary and when they were clamped by a concurrent infusion of glucose, somatostatin, and insulin. When plasma glucose, insulin, and glucagon were permitted to vary during beta adrenergic blockade, plasma glucose and glucose production increased, respectively, 32% and 42% less and plasma epinephrine concentrations were threefold greater than those during infusion of epinephrine alone; plasma insulin decreased during beta blockade but increased during infusion of epinephrine alone; glucose clearance was comparably suppressed in both instances. When alpha adrenergic blockade was superimposed on beta blockade, the increase in glucose production and the decrease in both plasma insulin and glucose clearance observed during infusion of epinephrine alone was virtually abolished. In contrast, when plasma glucose, insulin, and glucagon were clamped, beta adrenergic blockade completely prevented the suppression of glucose clearance by epinephrine and inhibited the stimulation of glucose production by epinephrine by 80% whereas alpha adrenergic blockade had no effect on either of these parameters. These results indicate that in man, epinephrine increases glucose production and decreases glucose clearance by both alpha and beta adrenergic actions. The alpha adrenergic effects could be accounted for by inhibition of insulin secretion. The mechanism for the beta adrenergic effects remains to be defined but may reflect a direct action of epinephrine on hepatic and peripheral tissues.

Adult↗
PubMed1980

Glucose clamping using the Biostator GCIIS.

The Biostator GCIIS was used to clamp circulating glucose at hypoglycemic (42 +/- 1 mg/dl), euglycemic (86 +/- 2 mg/dl), and hyperglycemic (142 +/- 1 mg/dl) levels in normal subjects during a concomitant infusion of insulin (0.1 U/kg/h). Because of limitations in maximal glucose infusion (1 g/min) from the Biostator, a supplementary infusion of glucose was required to accomplish euglycemic and hyperglycemic clamps. The coefficients of variation of blood glucose were 7.06 +/- 1.3%, 5.9 +/- 0.5%, and 6.1 +/- 0.9 for 120 minutes of hypoglycemic, euglycemic, and hyperglycemic clamps, respectively. Despite the occasional interruption of blood flow in the double-lumen catheter and the occasional poor correlation between Biostator and reference glucose method, satisfactory glucose clamps could be maintained for 2 hours.

Adult↗
PubMed1980

Pancreatic alpha and beta cell function in familial dysbetalipoproteinemia.

Resistance to both insulin and glucagon have been considered as possible causes of primary hypertriglyceridemia. In the present research, we have compared insulin and glucagon secretion in five hyperlipidemic patients with familial dysbetalipoproteinemia with five normolipidemic control subjects matched for age, sex and adiposioty. Plasma insulin and glucagon concentrations mesaured during standard oral glucose tolerance and arginine infusion tests were similar in the two groups. Blood glucose fell transiently in the controls, but not in the patients, during the Himsworth test (100 g glucose orally plus 0.05 U insulin per kg body weight intravenously). There were no significant differences in plasma FFA concentrations and responses during all tests between the groups. The percentage reduction in plasma triglyceride concentration during infusion of arginine was similar in the two groups. These results suggest that the patients with familial dysbetalipoproteinemia were slightly less insulin sensitive than the controls. However, primary insensitivity to glucagon or insulin does not appear to be fundamental to the pathogenesis of hyperlipidemia in familial dysbetalipoproteinemia.

Adult↗
PubMed1980

Effect of alpha-adrenergic stimulation and its blockade on glucose turnover in man.

Epinephrine (50 ng . kg-1 . min-1) was infused for 120 min in seven normal volunteers alone (combined alpha- and beta-adrenergic stimulation), with propranolol (alpha-adrenergic stimulation), and with propranolol plus phentolamine (alpha-adrenergic blockade superimposed on alpha-adrenergic stimulation). During alpha-adrenergic stimulation, plasma glucose and glucose production increased 32 and 42% less, respectively, than during infusion of epinephrine alone, whereas glucose clearance was suppressed comparably. Plasma insulin decreased during alpha-adrenergic stimulation but increased during infusion of epinephrine alone. Plasma epinephrine was threefold greater during infusion of epinephrine plus propranolol than during infusion of epinephrine alone. When alpha-adrenergic blockade was superimposed on alpha-adrenergic stimulation, the increases in plasma glucose and glucose production as well as the decreases in plasma insulin and glucose clearance observed during alpha-adrenergic stimulation were virtually abolished, whereas plasma epinephrine levels were unaltered. These results indicate that in man epinephrine can cause hyperglycemia via both alpha- and beta-adrenergic stimulation of glucose production and suppression of glucose clearance, either directly or indirectly. alpha-Adrenergic effects on glucose production and clearance may be mediated by inhibition of insulin secretion.

Adult↗
PubMed1980

Adrenergic mechanisms for the effects of epinephrine on glucose production and clearance in man.

THE PRESENT STUDIES WERE UNDERTAKEN TO ASSESS THE ADRENERGIC MECHANISMS BY WHICH EPINEPHRINE STIMULATES GLUCOSE PRODUCTION AND SUPPRESSES GLUCOSE CLEARANCE IN MAN: epinephrine (50 ng/kg per min) was infused for 180 min alone and during either alpha (phentolamine) or beta (propranolol)-adrenergic blockade in normal subjects under conditions in which plasma insulin, glucagon, and glucose were maintained at comparable levels by infusion of somatostatin (100 mug/h), insulin (0.2 mU/kg per min), and variable amounts of glucose. In additional experiments, to control for the effects of the hyperglycemia caused by epinephrine, variable amounts of glucose without epinephrine were infused along with somatostatin and insulin to produce hyperglycemia comparable with that observed during infusion of epinephrine. This glucose infusion suppressed glucose production from basal rates of 1.8+/-0.1 to 0.0+/-0.1 mg/kg per min (P < 0.01), but did not alter glucose clearance. During infusion of epinephrine, glucose production increased transiently from a basal rate of 1.8+/-0.1 to a maximum of 3.0+/-0.2 mg/kg per min (P < 0.01) at min 30, and returned to near basal rates at min 180 (1.9+/-0.1 mg/kg per min). Glucose clearance decreased from a basal rate of 2.0+/-0.1 to 1.5+/-0.2 ml/kg per min at the end of the epinephrine infusion (P < 0.01). Infusion of phentolamine did not alter these effects of epinephrine on glucose production and clearance. In contrast, infusion of propranolol completely prevented the suppression of glucose clearance by epinephrine, and inhibited the stimulation of glucose production by epinephrine by 80+/-6% (P < 0.001). These results indicate that, under conditions in which plasma glucose, insulin, and glucagon are maintained constant, epinephrine stimulates glucose production and inhibits glucose clearance in man predominantly by beta adrenergic mechanisms.

Adult↗