Chen Sheng-Song, Santomango Tammy S, Williams Phillip E, Lacy D Brooks, McGuinness Owen P
Department of Molecular Physiology, Vanderbilt University, Nashville, TN 37232-061, USA.
Am J Physiol Endocrinol Metab. 2009 May;296(5):E1172-8. doi: 10.1152/ajpendo.90821.2008. Epub 2009 Feb 10.
Glucose, fat, and glucagon availability are increased in diabetes. The normal response of the liver to chronic increases in glucose availability is to adapt to become a marked consumer of glucose. Yet this fails to occur in diabetes. The aim was to determine whether increased glucagon and lipid interact to impair the adaptation to increased glucose availability. Chronically catheterized well controlled depancreatized conscious dogs (n = 21) received 3 days of continuous parenteral nutrition (TPN) that was either high in glucose [C; 75% nonprotein calories (NPC)] or in lipid (HL; 75% NPC) in the presence or absence of a low dose (one-third basal) chronic intraportal infusion of glucagon (GN; 0.25 ng.kg(-1).min(-1)). During the 3 days of TPN, all groups received the same insulin algorithm; the total amount of glucose infused (GIR) was varied to maintain isoglycemia ( approximately 120 mg/dl). On day 3 of TPN, hepatic metabolism was assessed. Glucose and insulin levels were similar in all groups. GIR was decreased in HL and C + GN ( approximately 30%) and was further decreased in HL + GN (55%). Net hepatic glucose uptake was decreased approximately 15% in C + GN, and HL and was decreased approximately 50% in HL + GN. Lipid alone or combined with glucagon decreased glucose uptake by peripheral tissues. Despite impairing whole body glucose utilization, HL did not limit whole body energy disposal. In contrast, glucagon suppressed whole body energy disposal irrespective of the diet composition. In summary, failure to appropriately suppress glucagon secretion adds to the dietary fat-induced impairment in both hepatic and peripheral glucose disposal. In addition, unlike increasing the percentage of calories as fat, inappropriate glucagon secretion in the absence of compensatory hyperinsulinemia limits whole body nutrient disposition.
糖尿病患者体内葡萄糖、脂肪和胰高血糖素的可利用性增加。肝脏对葡萄糖可利用性长期增加的正常反应是适应成为葡萄糖的大量消耗者。然而,这种情况在糖尿病患者中并未发生。本研究旨在确定胰高血糖素和脂质增加是否相互作用,损害对葡萄糖可利用性增加的适应性。将21只长期插管且血糖控制良好的去胰腺清醒犬,在有或无低剂量(基础量的三分之一)慢性门静脉内输注胰高血糖素(GN;0.25 ng·kg⁻¹·min⁻¹)的情况下,接受3天的持续肠外营养(TPN),TPN的葡萄糖含量高[C组;75%非蛋白热量(NPC)]或脂质含量高(HL组;75% NPC)。在TPN的3天期间,所有组接受相同的胰岛素方案;输注的葡萄糖总量(GIR)有所变化以维持血糖水平恒定(约120 mg/dl)。在TPN的第3天,评估肝脏代谢。所有组的葡萄糖和胰岛素水平相似。HL组和C + GN组的GIR降低了约30%,HL + GN组进一步降低了55%。C + GN组、HL组的肝脏葡萄糖净摄取量降低了约15%,HL + GN组降低了约50%。单独的脂质或与胰高血糖素联合使用会降低外周组织对葡萄糖的摄取。尽管HL组损害了全身葡萄糖利用,但并未限制全身能量消耗。相比之下,无论饮食组成如何,胰高血糖素都会抑制全身能量消耗。总之,未能适当抑制胰高血糖素分泌会加重饮食脂肪诱导的肝脏和外周葡萄糖处置受损。此外,与增加脂肪热量百分比不同,在没有代偿性高胰岛素血症的情况下,不适当的胰高血糖素分泌会限制全身营养物质的处置。