Gw. Cline et al., MECHANISM OF IMPAIRED INSULIN-STIMULATED MUSCLE GLUCOSE-METABOLISM INSUBJECTS WITH INSULIN-DEPENDENT DIABETES-MELLITUS, The Journal of clinical investigation, 99(9), 1997, pp. 2219-2224
To determine the mechanism of impaired insulin-stimulated muscle glyco
gen metabolism in patients with poorly controlled insulin-dependent di
abetes mellitus (IDDM), we used C-13-NMR spectroscopy to monitor the p
eak intensity of the C1 resonance of the glucosyl units in muscle glyc
ogen during a 6-h hyperglycemic-hyperinsulinemic clamp using [1-C-13]g
lucose-enriched infusate followed by nonenriched glucose. Under simila
r steady state (t=3-6 h) plasma glucose (similar to 9.0 mM) and insuli
n concentrations (similar to 400 pM), nonoxidative glucose metabolism
was significantly less in the IDDM subjects compared with age-weight-m
atched control subjects (37+/-6 vs. 73+/-11 mu mol/kg of body wt per m
inute, P <0.05), which could be attributed to an similar to 45% reduct
ion in the net rate of muscle glycogen synthesis in the IDDM subjects
compared with the control subjects (108+/-16 vs. 195+/-6 mu mol/liter
of muscle per minute, P <0.001). Muscle glycogen turnover in the IDDM
subjects was significantly less than that of the controls (16+/-4 vs,
33+/-5%, P <0.05), indicating that a marked reduction in flux through
glycogen synthase was responsible for the reduced rate of net glycogen
synthesis in the IDDM subjects. P-31-NMR spectroscopy was used to det
ermine the intramuscular concentration of glucose-6-phosphate (G-6-P)
under the same hyperglycemic-hyperinsulinemic conditions. Basal Ga-P c
oncentration was similar between the two groups (similar to 0.10 mmol/
kg of muscle) but the increment in G-6-P concentration in response to
the glucose-insulin infusion was similar to 50% Less in the IDDM subje
cts compared with the control subjects (0.07+/-0.02 vs. 0.13+/-0.02 mm
ol/kg of muscle, P <0.05). When nonoxidative glucose metabolic rates i
n the control subjects were matched to the IDDM subjects, the incremen
t in the G-6-P concentration (0.06+/-0.02 mmol/kg of muscle) was no di
fferent than that in the IDDM subjects. Together, these data indicate
that defective glucose transport/phosphorylation is the major factor r
esponsible for the lower rate of muscle glycogen synthesis in the poor
ly controlled insulin-dependent diabetic subjects.