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1 Departments of Physiology and 2 Medicine, and 3 Division of Comparative Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada; and 4 Department of Medicine, Juntendo University, Tokyo 113-0033, Japan
In our previous studies in nondiabetic
dogs and humans, insulin suppressed glucose production (GP) by both an
indirect extrahepatic and a direct hepatic effect. However, insulin had
no direct effect on GP in diabetic depancreatized dogs under conditions
of moderate hyperglycemia. The present study was designed to
investigate whether insulin can inhibit GP by a direct effect in this
model under conditions of euglycemia. Depancreatized dogs were made
euglycemic (~6 mmol/l), rather than moderately hyperglycemic (~10
mmol/l) as in our previous studies, by basal portal insulin infusion. After ~100 min of euglycemia, a hyperinsulinemic euglycemic clamp was
performed by giving an additional infusion of insulin either portally
(POR) or peripherally at about one-half the rate (1/2 PER) to match the
peripheral venous insulin concentrations. The greater hepatic insulin
load in POR resulted in greater suppression of GP (from 16.5 ± 1.8 to 12.2 ± 1.6 µmol · kg
1 · min
1)
than 1/2 PER (from 17.8 ± 1.9 to 15.6 ± 2.0 µmol · kg
1 · min
1,
P < 0.001 vs. POR), consistent with insulin having a
direct hepatic effect in suppressing GP. We conclude that the direct effect of insulin to inhibit GP is present in diabetic depancreatized dogs under conditions of acutely induced euglycemia. These results suggest that, in diabetes, the prevailing glycemic level is a determinant of the balance between insulin's direct and indirect effects on GP.
peripheral and hepatic effects of insulin; direct and indirect effects of insulin; hyperglycemia; free fatty acids
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