Hm. Farrag et al., PERSISTENT GLUCOSE-PRODUCTION AND GREATER PERIPHERAL SENSITIVITY TO INSULIN IN THE NEONATE VS THE ADULT, American journal of physiology: endocrinology and metabolism, 35(1), 1997, pp. 86-93
Insulin resistance has been reported to partially explain the clinical
appearance of neonatal hyperglycemia. To determine the relative resis
tance to insulin of glucose production vs. glucose utilization, the eu
glycemic hyperinsulinemic damp technique was employed for the first ti
me in the human neonate and was combined with stable isotopic determin
ation of glucose production and glucose utilization. The basal rates o
f glucose production and glucose utilization mere determined, after wh
ich each neonate was clamped at his or her own euglycemic glucose conc
entration while receiving regular human insulin at one rate of 0.2, 0.
5, 1.0, 2.0, or 4.0 mU . kg(-1) . min(-1). Persistent glucose producti
on (greater than or equal to 1 mg . kg(-1) . min(-1)) during the clamp
was recorded for all groups. A significant increase in the glucose in
fusion rate (P < 0.001) and in percent glucose utilization (P < 0.01)
occurred in the 2.0 and 4.0 mU . kg(-1) . min(-1) insulin groups. Meta
bolic clearance rate of insulin was significantly greater in the neona
te compared with the adult at the 2.0 mU . kg(-1) . min(-1) insulin in
fusion rate (P = 0.036). Our results indicate that, in contrast to the
adult, the neonate has persistent glucose production (P = 0.001) and
greater peripheral sensitivity to insulin (P = 0.015).