Insulin Sensitivity Accounts for Glucose and Lactate Kinetics After Intravenous Glucose Injection

Abstract

Mathematical modeling was used to explore the interaction between glucose, insulin, and lactate during the frequently sampled intravenous glucose tolerance test (FSIGTT). Insulin-modified FSIGTs were performed in 25 lean volunteers, and an additional 5 volunteers underwent FSIGTs with glucose injection alone to illustrate the effect of insulin on both glucose and lactate kinetics. The model chosen as the best representation of the system extended the minimal model of glucose kinetics (MM) by including a two-compartment model of lactate kinetics. The model accounted for both glucose and lactate kinetics, provided traditional MM parameters of insulin sensitivity and glucose effectiveness, and descriptive parameters of lactate kinetics. Modeling suggested that lactate production was limited by the rate of glucose disappearance, with no indication of direct effects of insulin on lactate. Inclusion of lactate kinetics had no adverse effect on MM parameters (SG: 0.023 ± 0.009 vs. 0.023 ± 0.010 min−1,SI: 1.01 ± 0.70 vs. 1.03 ± 0.71 × 104 · min−1 · pmol−1 · 1; P < 0.50, lactate model vs. MM), and indicated that ∼1.2% min−1 of total glucose disappearance during the FSIGT is converted to lactate. An additional benefit of including lactate kinetics was the significant improvement in precision in MM parameter estimates as reflected by the fractional standard deviations (FSDs). This effect was most prominent for SG, in which a threefold improvement in parameter precision was observed (FSD: 13.5 ± 3.1 vs. 42.5 ± 48.5; means ± SD). These analyses indicate that kinetic information for both glucose and lactate can be derived from FSIGT data and provide insights into the interaction between glucose, insulin, and lactate under non-steady-state conditions.