INDUCTION OF HYPERINSULINEMIA COMBINED WITH HYPERGLYCEMIA AND HYPERTRIGLYCERIDEMIA INCREASES PLASMINOGEN-ACTIVATOR INHIBITOR-1 IN BLOOD IN NORMAL HUMAN-SUBJECTS

Hypofibrinolysis caused by increased plasminogen activator inhibitor 1 (PAI-1) has been implicated in the vasculopathy of type 2 diabetes, t ypified by increased insulin, glucose, and triglycerides. However, sho rt-term infusions of insulin have not increased PAI-1 in normal subjec ts. We hypothesized that induction of increased insulin accompanied by increased glucose and triglycerides would increase PAI-1, accordingly ; 30% glucose and 10% Intralipid were infused for 6 it int ten normal lean individuals (54 +/- 3 years) resulting in increased insulin (42 /- 5 mu U/dl), glucose (200 +/- 24 mg/dl), and triglycerides (425 +/- 45 mg/dl), simulating changes in type! 2 diabetes, hn contrast to resu lts with infusion of saline alone Cn = 16) and euglycemic-hyperinsulin emic clamps (n = 10, serum insulin = 89 +/- 7 mu U/dl), PAI-1 in blood increased significantly 6 h after the onset of infusion (15 +/- 5 ng/ ml, P < 0.05 vs. baseline = 7.4 +/- 1.1, saline 6 h = 3.4 +/- 1.1, and insulin alone 6 h = 3.7 +/- 0.8) and remained elevated for an additio nal 6 h (combined infusion = 13.8 +/- 3.8 ng/ml, saline = 6.7 +/- 2 ng /ml, insulin alone = 7.8 +/- 1.7 ng/ml, P = 0.06), Our data suggest th at combined hyperinsulemia, hypertriglyceridemia, and hyperglycemia ar e likely to contribute to hypofibrinolysis of type 2 diabetes by incre asing the blood levels of PAI-1, Moreover, these results underscore th e potential importance of modifying insulin resistance as n ell as ach ieving glycemic and lipidemic control in individuals with type 2 diabe tes.