AJP - Endocrinology and Metabolism, Vol 268, Issue 4 E766-E774, Copyright © 1995 by American Physiological Society
A simulation model for glucose kinetics and estimates of glucose utilization rate in type 1 diabetic patients
M. A. Boroujerdi, A. M. Umpleby, R. H. Jones and P. H. Sonksen
Department of Medicine, United Medical School, London, United Kingdom.
A glucose kinetic model is described that contains insulin-independent and
insulin-dependent pathways of glucose uptake and includes a saturating flux
term for glucose transport into the cells by the glucose transporters. The
rate of glucose utilization was estimated in control subjects and diabetic
patients by use of a bolus of [3-3H]glucose. Diabetic patients were studied
after three regimens of insulin therapy: 1) after 24 h of insulin
withdrawal, 2) after conventional insulin therapy, and 3) after an
overnight insulin infusion such that plasma glucose was maintained between
4 and 6 mmol/l. In addition, the model was used to simulate published
results from glucose clamp experiments with a range of glycemic levels and
insulin concentrations. Estimates of glucose utilization flux in diabetic
patients and model simulation suggest that high plasma glucose
concentrations in uncontrolled diabetic patients can be attributed to a
high glucose production rate by the liver associated with a reduction in
glucose metabolic clearance rate due to relative saturation of the
available pool of glucose transporters.
