Vol. 283, Issue 1, E78-E84, July 2002
Epinephrine effects on insulin-glucose dynamics: the
labeled IVGTT two-compartment minimal model approach
Paolo
Vicini1,
Angelo
Avogaro2,
Mary
E.
Spilker1,
Alessandra
Gallo2, and
Claudio
Cobelli3
1 Department of Bioengineering, University of
Washington, Seattle, Washington 98195; 2 Departments of
Metabolic Diseases and 3 Electronics and Informatics,
University of Padova, 35128 Padua, Italy
The hyperglycemic effects of
epinephrine (Epi) are established; however, the modulation of
Epi-stimulated endogenous glucose production (EGP) by glucose and
insulin in vivo in humans is less clear. Our aim was to determine the
effect of exogenously increased plasma Epi concentrations on insulin
and glucose dynamics. In six normal control subjects, we used the
labeled intravenous glucose tolerance test (IVGTT) interpreted with the
two-compartment minimal model, which provides not only glucose
effectiveness (S
), insulin sensitivity
(S
), and plasma clearance rate (PCR) at basal state,
but also the time course of EGP. Subjects were randomly studied during
either saline or Epi infusion (1.5 µg/min). Exogenous Epi infusion
increased plasma Epi concentration to a mean value of 2,034 ± 138 pmol/l. During the stable-label IVGTT, plasma glucose, tracer glucose,
and insulin concentrations were significantly higher in the Epi study.
The hormone caused a significant (P < 0.05) reduction in
PCR in the Epi state when compared with the basal state. The
administration of Epi has a striking effect on EGP profiles: the nadir
of the EGP profiles occurs at 21 ± 7 min in the basal state and
at 55 ± 13 min in the Epi state (P < 0.05). In
conclusion, we have shown by use of a two-compartment minimal model of
glucose kinetics that elevated plasma Epi concentrations have profound
effects at both hepatic and tissue levels. In particular, at the liver
site, this hormone deeply affects, in a time-dependent fashion, the
inhibitory effect of insulin on glucose release. Our findings may
explain how even a normal subject may have the propensity to develop
glucose intolerance under the influence of small increments of Epi
during physiological stress.
insulin action; endogenous glucose production; glucose
effectiveness