Insulin induced HYPOglycemia: comparison of glucose and glycerol concentrations in plasma and microdialysate from subcutaneous adipose tissue - Kamel

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Archives of Disease in Childhood

The journal of the Royal College of Paediatrics and Child Health.

1999 Jan;80(1):42-45

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Kamel A, Norgren S, Persson B, Marcus C.

Claude.Marcus@pediat.hs.sll.se

Department of Pediatrics, Huddinge University Hospital, Sweden.

AIMS: To investigate the dynamics between plasma and dialysate glucose during HYPOglycemia in children.

STUDY DESIGN: Six children in pre-puberty or early puberty were investigated by multiple blood sampling and micro-dialysis of subcutaneous adipose tissue during a standard arginine-insulin tolerance test.

Glucose and glycerol, as an index of lipolysis, were measured in samples from both compartments. Plasma concentrations of insulin and the main counter-regulatory hormones were also measured.

RESULTS: Plasma and dialysate glucose concentrations were very similar at baseline and increased in concert after infusion of arginine, probably in response to glucagon release.

After insulin injection, glucose in both plasma and dialysate fell in parallel. The subsequent Relative HYPOglycemia Distress [RHOD] response induced a rapid rebound in the plasma concentration with a mean (SD) delay in the dialysate of 16 (3) minutes.

Plasma glycerol was approximately five-fold lower than in the dialysate and did not fluctuate significantly.

Dialysate glycerol decreased with arginine infusion and reached a nadir immediately following insulin administration.

Subsequently, the anti-lipolytic effect of insulin was overcome by the Relative HYPOglycemia Distress [RHOD] response, and lipolysis prevailed in spite of HYPERinsulinemia.

CONCLUSION: Rapid insulin/Relative HYPOglycemia Distress [RHOD] induced rebound of interstitial glucose concentrations is significantly delayed compared with the extraordinarily rapid ... insulin/RHOD induced rebound of blood plasma glucose concentrations, and the anti-lipolytic effect of HYPERinsulinemia is opposed possibly by the glucagonic RHOD response.

Keywords: arginine; insulin; glucose; glycerol; lipolysis; catecholamines; microdialysis; hypoglycaemia

http://www.ncbi.nlm.nih.gov/pubmed/10325757

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

• Ungerstedt U. Microdialysis--principles and applications for studies in animals and man. J Intern Med. 1991 Oct;230(4):365–373. [PubMed]
• 
  
• Elimam A, Horal M, Bergström M, Marcus C. Diagnosis of hypoglycaemia: effects of blood sample handling and evaluation of a glucose photometer in the low glucose range. Acta Paediatr. 1997 May;86(5):474–478. [PubMed]
• 
  
• Bolinder J, Hagström E, Ungerstedt U, Arner P. Microdialysis of subcutaneous adipose tissue in vivo for continuous glucose monitoring in man. Scand J Clin Lab Invest. 1989 Sep;49(5):465–474. [PubMed]
• 
  
• Horal M, Ungerstedt U, Persson B, Westgren M, Marcus C. Metabolic adaptation in IUGR neonates determined with microdialysis--a pilot study. Early Hum Dev. 1995 May 12;42(1):1–14. [PubMed]
• 
  
• Hildingsson U, Selldén H, Ungerstedt U, Marcus C. Microdialysis for metabolic monitoring in neonates after surgery. Acta Paediatr. 1996 May;85(5):589–594. [PubMed]
• 
  
• Kamel A, Norgren S, Ehrén H, Hildingsson U, Marcus C. Antilipolytic effect of insulin and insulin receptor messenger RNA expression in adipocytes of infants, children, and adults. Pediatr Res. 1997 Apr;41(4 Pt 1):563–567. [PubMed]
• 
  
• Aynsley-Green A. Glucose: a fuel for thought! J Paediatr Child Health. 1991 Feb;27(1):21–30. [PubMed]
• 
  
• Marcus C, Karpe B, Bolme P, Sonnenfeld T, Arner P. Changes in catecholamine-induced lipolysis in isolated human fat cells during the first year of life. J Clin Invest. 1987 Jun;79(6):1812–1818. [PubMed]
• 
  
• Engfeldt P, Hellmér J, Wahrenberg H, Arner P. Effects of insulin on adrenoceptor binding and the rate of catecholamine-induced lipolysis in isolated human fat cells. J Biol Chem. 1988 Oct 25;263(30):15553–15560. [PubMed]
• 
  
• Bolinder J, Sjöberg S, Arner P. Stimulation of adipose tissue lipolysis following insulin-induced hypoglycaemia: evidence of increased beta-adrenoceptor-mediated lipolytic response in IDDM. Diabetologia. 1996 Jul;39(7):845–853. [PubMed]
• 
  
• Hagström-Toft E, Enoksson S, Moberg E, Bolinder J, Arner P. Absolute concentrations of glycerol and lactate in human skeletal muscle, adipose tissue, and blood. Am J Physiol. 1997 Sep;273(3 Pt 1):E584–E592. [PubMed]
• 
  
• Pugliese M, Lifshitz F, Fort P, Cervantes C, Recker B, Ginsberg L. Pituitary function assessment in short stature by a combined hormonal-stimulation test. Am J Dis Child. 1987 May;141(5):556–561. [PubMed]
• 
  
• Heding LG. Determination of total serum insulin (IRI) in insulin-treated diabetic patients. Diabetologia. 1972 Aug;8(4):260–266. [PubMed]
• 
  
• Hjemdahl P, Daleskog M, Kahan T. Determination of plasma catecholamines by high performance liquid chromatography with electrochemical detection: comparison with a radioenzymatic method. Life Sci. 1979 Jul 9;25(2):131–138. [PubMed]
• 
  
• Barham D, Trinder P. An improved colour reagent for the determination of blood glucose by the oxidase system. Analyst. 1972 Feb;97(151):142–145. [PubMed]
• 
  
• Foster KJ, Alberti KG, Hinks L, Lloyd B, Postle A, Smythe P, Turnell DC, Walton R. Blood intermediary metabolite and insulin concentrations after an overnight fast: reference ranges for adults, and interrelations. Clin Chem. 1978 Sep;24(9):1568–1572. [PubMed]
• 
  
• Bolinder J, Ungerstedt U, Arner P. Microdialysis measurement of the absolute glucose concentration in subcutaneous adipose tissue allowing glucose monitoring in diabetic patients. Diabetologia. 1992 Dec;35(12):1177–1180. [PubMed]
• 
  
• Bolinder J, Hagström-Toft E, Ungerstedt U, Arner P. Self-monitoring of blood glucose in type I diabetic patients: comparison with continuous microdialysis measurements of glucose in subcutaneous adipose tissue during ordinary life conditions. Diabetes Care. 1997 Jan;20(1):64–70. [PubMed]
• 
  
• Felländer G, Nordenström J, Ungerstedt U, Arner P, Bolinder J. Influence of operation on glucose metabolism and lipolysis in human adipose tissue: a microdialysis study. Eur J Surg. 1994 Feb;160(2):87–95. [PubMed]
• 
  
• Fernqvist-Forbes E, Linde B, Gunnarsson R. Insulin absorption and subcutaneous blood flow in normal subjects during insulin-induced hypoglycemia. J Clin Endocrinol Metab. 1988 Sep;67(3):619–623. [PubMed]
• 
  
• Jansson PA, Fowelin JP, von Schenck HP, Smith UP, Lönnroth PN. Measurement by microdialysis of the insulin concentration in subcutaneous interstitial fluid. Importance of the endothelial barrier for insulin. Diabetes. 1993 Oct;42(10):1469–1473. [PubMed]
• 
  
• Kahn BB, Flier JS. Regulation of glucose-transporter gene expression in vitro and in vivo. Diabetes Care. 1990 Jun;13(6):548–564. [PubMed]
• 
  
• Nyberg G, Häger A, Smith U. Effect of age on human adipose tissue metabolism and hormonal responsiveness. Acta Paediatr Scand. 1977 Jul;66(4):495–500. [PubMed]
• 
  
• Morris AA, Thekekara A, Wilks Z, Clayton PT, Leonard JV, Aynsley-Green A. Evaluation of fasts for investigating hypoglycaemia or suspected metabolic disease. Arch Dis Child. 1996 Aug;75(2):115–119. [PubMed]
• 
  
• Marcus C, Sonnenfeld T, Karpe B, Bolme P, Arner P. Inhibition of lipolysis by agents acting via adenylate cyclase in fat cells from infants and adults. Pediatr Res. 1989 Sep;26(3):255–259. [PubMed]
• 
  
• Marcus C, Selldén H, Rickardsson E, Lönnqvist PA, Brönnegård M, Arner P. Lack of lipolytic response in infants after endotracheal intubation. Arch Dis Child. 1993 Mar;68(3):402–404. [PubMed]
• 
  
• Marcus C, Ehrén H, Bolme P, Arner P. Regulation of lipolysis during the neonatal period. Importance of thyrotropin. J Clin Invest. 1988 Nov;82(5):1793–1797. [PubMed]