The effect of graded doses of insulin on peripheral glucose uptake and lactate release in cancer cachexia Journal Article
| Authors: | Cersosimo, E.; Pisters, P. W. T.; Pesola, G.; Rogatko, A.; Vydelingum, N. A.; Bajorunas, D.; Brennan, M. F. |
| Article Title: | The effect of graded doses of insulin on peripheral glucose uptake and lactate release in cancer cachexia |
| Abstract: | With the euglycemic clamp technique, we evaluated the effects of graded doses of insulin on glucose turnover rates and forearm lactate balance in five weight-losing patients with cancer before surgery and five age- and weight-matched healthy volunteers (control subjects). Insulin was infused sequentially at increasing rates of 0.5 (low physiologic), 1.0 (high physiologic), and 4.0 (supraphysiologic) mU/kg.min for 120 minutes each. Concurrently, rates of glucose appearance and disappearance were derived from [3-H-3] glucose infusion. The mean postabsorptive rate of glucose appearance in patients (2.9 +/- 0.1 mg/kg . min) was significantly higher (p < 0.02) than that of control subjects (1.98 +/- 0.16 mg/kg . min). Complete suppression of endogenous glucose production occurred at high physiologic insulin concentrations. With progressive insulin infusion, the rate of glucose disappearance increased to 3.6 +/- 1.2, 8.7 +/- 0.8, and 13.7 +/- 1.1 mg/kg/min in control subjects and 2.9 +/- 0.4, 5.3 +/- 0.3, and 10.9 +/- 0.9 mg/kg . min in patients, significantly different from that of control subjects (p < 0.05) during the intermediate (high physiologic) insulin infusion. A comparable slight increase in arterial plasma lactate concentration was observed in both groups with progressive hyperinsulinemia. Baseline peripheral lactate flux was identical in patients (-272 +/- 56 nmol/100 gm . min) and in controls (-271 +/- 57 nmol/100 gm . min). Progressive physiologic hyperinsulinemia resulted in significantly (p < 0.05) augmented peripheral lactate efflux in patients (-824 +/- 181 nmol/100 gm . min) compared with control subjects (-287 +/- 64 nmol/100 gm . min). Supraphysiologic insulin abolished this increased lactate efflux in patients. Postabsorptive rates of endogenous glucose appearance in weight-losing patients with cancer were elevated, but complete suppression was achieved with insulin concentrations in the physiologic range. Total body glucose use was diminished in these patients, consistent with a state of insulin resistance. This impaired insulin action on peripheral glucose use was associated with an increase in peripheral lactate release in patients. |
| Keywords: | resistance; muscle; patient; colorectal-cancer; hyperinsulinemia; total parenteral-nutrition; turnover; metabolic response; lactic-acidosis; weight-losing cancer |
| Journal Title: | Surgery |
| Volume: | 109 |
| Issue: | 4 |
| ISSN: | 0039-6060 |
| Publisher: | Elsevier Inc. |
| Date Published: | 1991-04-01 |
| Start Page: | 459 |
| End Page: | 467 |
| Language: | English |
| ACCESSION: | WOS:A1991FF16600003 |
| PROVIDER: | wos |
| PUBMED: | 2008651 |
| Notes: | Article -- Source: Wos |
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