Glucose and fat utilization during intravenous administration of glucose and lipid emulsion in non-insulin-dependent diabetic patients.

To evaluate the clinical significance of substrate competition in the insulin-resistant state, we measured glucose and lipid utilization in 10 non-insulin-dependent diabetic patients during an isoglycemic hyperinsulinemic (approximately 75 and approximately 1500 mU/L) clamp without and with the concomitant infusion of Intralipid (0.15 g triglycerides.kg-1 x h-1) and during Intralipid infusion only in combination with indirect calorimetry. We found that a lipid emulsion does not alter the metabolic clearance rates of glucose at insulinemias of approximately 75 mU/L (5.58 +/- 2.56 vs. 6.03 +/- 2.43 ml.kg-1 x min-1) and approximately 1500 mU/L (13.55 +/- 3.17 vs. 13.75 +/- 4.36 ml.kg-1 x min-1) and it does not change oxidative and nonoxidative glucose disposal rates. Insulin and glucose attenuate the Intralipid-induced increase in serum triglycerides, free fatty acids, and lipid oxidation. We conclude that, whereas Intralipid infused at a standard rate does not decrease glucose utilization under hyperinsulinemic conditions, its own removal from the plasma is enhanced by glucose and insulin in non-insulin-dependent diabetic patients.