Vranic M, Kawamori R, Pek S, Kovacevic N, Wrenshall G A
J Clin Invest. 1976 Feb;57(2):245-55. doi: 10.1172/JCI108275.
In order to elucidate the role of insulin and glucagon during strenuous exercise (100 m/min, slope 10-12 degrees), we have determined the rates of production (Ra), utilization (Rd), and metabolic clearance (M) of glucose in normal dogs before pancreatectomy and 2 wk after total pancreatectomy (a) when they were being maintained on constant intraportal basal insulin infusion, (245 muU/kg-min) and (b) when insulin supply had been withheld before and during exercise. Such an intense exercise induced in normal dogs a prompt decrease in mean immunoreactive serum insulin (IRI) from 20 +/- 3 to 11 +/- 2 muU/ml. In depancreatized insulin-infused dogs serum IRI during rest and exercise was between 14 +/- 1 and 12 +/- 2 muU/ml. In the third group, after cessation of insulin infusion, IRI decreased by 76% (from 17 +/- 5 to 4 +/- 1) and did not decrease futher during exercise. During exercise, serum immunoreactive glucagon (IRG) increased threefold in normal dogs. In depancreatized dogs serum IRG was the same as in normal resting dogs (indicating a nonpancreatic source of the hormone) but it did not increase during exercise. In normal dogs exercise induced proportional increases in Ra, Rd, and M (threefold) and normoglycemia was maintained. Changes in glucose turnover in depancreatized insulin-infused dogs were similar to those seen in normal dogs suggesting that a decrease in insulin secretion and a rise in IRG are not essential to prevent hypoglycemia in diabetic dogs. With the cessation of insulin infusion in resting depancreatized dogs, Ra increased, M decreased, and hyperglycemia ensued. During exercise, Ra continued to rise, but M did not increase significantly.
(a) Regulation of glucose production by liver during exercise is multifactorial. A decrease in IRI and an increase in IRG are not the only factors which can promote delivery of glucose to the peripheral tissues. The insulin glucagon molar ratio was found not to be an essential metabolic functional unit in regulating glucose metabolism during exercise. (b) It is hypothesized that increases in blood flow and capillary surface area can lead to an increase in the amount of insulin delivered to the muscle even when serum levels of IRI are reduced during exercies. It is suggested that small, but adequate amounts of insulin (as found in normal and depancreatized insulin-infused dogs) are essential in regulating glucose uptake in the working muscle. (c) Since totally depancreatized dogs had normal serum levels of IRG (originating presumably from the gastrointestinal tract), the question of essentiality of basal glucagon activity in glucose homeostasis during exercise could not be resolved by these experiments. It appears, however, that regulation of secretion of nonpancreatic glucagon differs from that of pancreatic glucagon.
为了阐明胰岛素和胰高血糖素在剧烈运动(100米/分钟,坡度10 - 12度)中的作用,我们测定了正常犬在胰腺切除术前以及全胰腺切除术后2周时(a)持续经门静脉进行基础胰岛素输注(245微单位/千克 - 分钟)和(b)运动前及运动期间停止胰岛素供应时的葡萄糖生成率(Ra)、利用率(Rd)和代谢清除率(M)。这种剧烈运动使正常犬的平均免疫反应性血清胰岛素(IRI)迅速从20±3微单位/毫升降至11±2微单位/毫升。在胰腺切除术后接受胰岛素输注的犬中,静息和运动期间血清IRI在14±1至12±2微单位/毫升之间。在第三组中,停止胰岛素输注后,IRI下降了76%(从17±5降至4±1),并且在运动期间未进一步下降。运动期间,正常犬的血清免疫反应性胰高血糖素(IRG)增加了三倍。在胰腺切除术后的犬中,血清IRG与正常静息犬相同(表明该激素有非胰腺来源),但在运动期间未增加。在正常犬中,运动导致Ra、Rd和M成比例增加(三倍),并维持血糖正常。胰腺切除术后接受胰岛素输注的犬的葡萄糖周转率变化与正常犬相似,这表明胰岛素分泌减少和IRG升高对于预防糖尿病犬低血糖并非必不可少。在静息的胰腺切除术后犬停止胰岛素输注后,Ra增加,M下降,继而出现高血糖。运动期间,Ra持续上升,但M未显著增加。
(a)运动期间肝脏对葡萄糖生成的调节是多因素的。IRI降低和IRG升高并非促进葡萄糖向周围组织输送的唯一因素。发现胰岛素 - 胰高血糖素摩尔比在运动期间调节葡萄糖代谢中并非必需的代谢功能单位。(b)据推测,即使运动期间血清IRI水平降低,血流量和毛细血管表面积增加也可导致输送至肌肉的胰岛素量增加。建议少量但足够的胰岛素(如在正常犬和胰腺切除术后接受胰岛素输注的犬中所见)对于调节工作肌肉中的葡萄糖摄取至关重要。(c)由于全胰腺切除术后的犬血清IRG水平正常(可能源自胃肠道),这些实验无法解决运动期间基础胰高血糖素活性在葡萄糖稳态中的必要性问题。然而,似乎非胰腺来源的胰高血糖素的分泌调节与胰腺来源的胰高血糖素不同。