GLUCOSE AND FAT UTILIZATION DURING INTRAVENOUS ADMINISTRATION OF GLUCOSE AND LIPID EMULSION IN NON-INSULIN-DEPENDENT DIABETIC-PATIENTS

To evaluate the clinical significance of substrate competition in the insulin-resistant state, we measured glucose and lipid utilization in 10 non-insulin-dependent diabetic patients during an isoglycemic hyper insulinemic (approximately 75 and approximately 1500 mU/L) clamp witho ut and with the concomitant infusion of Intralipid (0. 15 g triglyceri des kg-1 h-1) and during Intralipid infusion only in combination with indirect calorimetry. We found that a lipid emulsion does not alter th e metabolic clearance rates of glucose at insulinemias of approximatel y 75 mU/L (5.58 +/- 2.56 vs. 6.03 +/- 2.43 ml kg-1 min-1) and approxim ately 1500 mU/L (13.55 +/- 3.17 vs. 13.75 +/- 4.36 ml kg-1 min-1) and it does not change oxidative and nonoxidative glucose disposal rates. Insulin and glucose attenuate the Intralipid-induced increase in serum triglycerides, free fatty acids, and lipid oxidation. We conclude tha t, whereas Intralipid infused at a standard rate does not decrease glu cose utilization under hyperinsulinemic conditions, its own removal fr om the plasma is enhanced by glucose and insulin in non-insulin-depend ent diabetic patients.