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1 Department of Diabetes and Metabolism, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH; and 2 Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham NG7 2RD, United Kingdom
To understand the day-to-day
pathophysiology of impaired muscle glycogen storage in type 2 diabetes,
glycogen concentrations were measured before and after the consumption
of sequential mixed meals (breakfast: 190.5 g carbohydrate, 41.0 g
fat, 28.8 g protein, 1,253 kcal; lunch: 203.3 g carbohydrate,
48.1 g fat, 44.0 g protein, 1,497.5 kcal) by use of natural
abundance 13C magnetic resonance spectroscopy. Subjects
with diet-controlled type 2 diabetes (n = 9) and age-
and body mass index-matched nondiabetic controls (n = 9) were studied. Mean fasting gastrocnemius glycogen concentration was
significantly lower in the diabetic group (57.1 ± 3.6 vs.
68.9 ± 4.1 mmol/l; P < 0.05). After the first
meal, mean glycogen concentration in the control group rose
significantly from basal (97.1 ± 7.0 mmol/l at 240 min;
P = 0.005). After the second meal, the high level of
muscle glycogen concentration in the control group was maintained, with
a further rise to 108.0 ± 11.6 mmol/l by 480 min. In the diabetic
group, the postprandial rise was markedly lower than that of the
control group (65.9 ± 5.2 mmol/l at 240 min, P < 0.005, and 70.8 ± 6.7 mmol/l at 480 min, P = 0.01) despite considerably greater serum insulin levels (752.0 ± 109.0 vs. 372.3 ± 78.2 pmol/l at 300 min, P = 0.013). This was associated with a significantly greater postprandial hyperglycemia (10.8 ± 1.3 vs. 5.3 ± 0.2 mmol/l at 240 min,
P < 0.005). Basal muscle glycogen concentration
correlated inversely with fasting blood glucose (r = 
0.55, P < 0.02) and fasting serum insulin
(r = 0.57, P < 0.02). The increment
in muscle glycogen correlated with initial increment in serum insulin
only in the control group (r = 0.87, P < 0.002). This study quantitates for the first time the subnormal
basal muscle glycogen concentration and the inadequate glycogen storage
after meals in type 2 diabetes.
type 2 diabetes; magnetic resonance spectroscopy; insulin resistance
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