Effects of Hyperglycemia on Glucose Production and Utilization in Humans: Measurement With [23H]-, [33H]-, and [614C]Glucose

Abstract

Studies with tritiated isotopes of glucose have demonstrated that hyperglycemia per se stimulates glucos utilization and suppresses glucose production in humans. These conclusions rely on the assumption that tritiated glucose provides an accurate measure of glucose turnover. However, if in the presence of hyperglycemia the isotope either loses its label during “futile” cycling or retains its label during cycling through glycogen, then this assumption is not valid. To examine this question, glucose utilization and glucose production rates were measuredin nine normal subjects with a simultaneous infusion of [23H]glucose, an isotope that may undergo futile cycling but does not cycle through glycogen; [614C]glucose, an isotope that may cycle through glycogen but does not futile cycle; and [33H]glucose, an isotope that can both undergo futile cycling and cycle through glycogen. In the postabsorptive state at plasma glucose concentration of 95 mg dl−1, glucose turnover determined with [614C]glucose (2.3 ±0.1 mg kg−1 min−1) was greater than that determined with [33H]glucose (2.1 ± 0.1 mg kg−1 min−1 P = 0.002) and slightly less than that determined with [23H]glucose (2.7 ± 0.2 mg kg−1 min−1 P = 0.08). Plasma glucose was then raised from 95 to 135 to 175 mg dl−1 while insulin secretion was inhibited, and circulating insulin, glucagon, and growth hormone concentrations were maintained constant by infusion of these hormones and somatostatin. Glucose production and utilization rates determined with [614C]-glucose continued to be less than those determined with [23H]glucose and greater than those seen with [33H]glucose. However, the decrements in glucose production and increments in glucose utilization were identical with all isotopes. Glucagon was then infused at a high rate to stimulate endogenous glucose release. This resulted in a significant (P < 0.05) increase in both [614C]- and [33H]- but not [23H]giucose, indicating release of the former two isotopes from glycogen. This resulted in a significantly lower (P < 0.04) estimate of glucose production and utilization during the glucagon infusion determined with [614C]- and [33H]glucose compared with that determined with [23H]glucose. Thus, whereas neither [23H]- nor [33H]glucose precisely reflect glucose turnover measured by [614C]glucose, all three isotopes provide an equivalent assessment of the effects of hyperglycemia on glucose production and utilization in humans. However, release of either [614C]- or [33H]glucose from glycogen may result in an underestimate Of glucose turnover.