insulin--isophane and Hyperinsulinism

This is the first report of the effects of a nonthiazolidinedione activator of peroxisome proliferator-activated receptor (PPAR) gamma, that is, FK-614 (a benzimidazole derivative), on glucose metabolism in vivo. To investigate the effect of FK-614 on peripheral and hepatic insulin action, we performed hyperinsulinemic-hyperglycemic clamp studies combined with the triple-catheter technique and a double-tracer approach in alloxan-diabetic dogs with (n=5) or without (n=6) treatment with FK-614 (0.32 mg/kg per day orally for 10 days). Throughout the experiment, insulin was infused intraportally at 18 pmol/kg per minute and hyperglycemia (approximately 11 mmol/L) was maintained by a peripheral glucose infusion. After a 45-minute basal period (period I), a portal infusion of glucose labeled with [U-14C]-glucose, was administered for 120 minutes (period II) to measure hepatic glucose uptake. This was followed by 90-minute recovery (period III). FK-614 marginally improved peripheral insulin sensitivity, did not affect hepatic glucose uptake, and surprisingly increased tracer-determined hepatic glucose production (19.0+/-5.0 vs 10.6+/-1.7 mumol/kg per minute, P<.001). Hepatic insulin extraction was decreased by FK-614 (47.8%+/-1.6% vs 55.9%+/-3.4%, P<.01), which led to greater peripheral insulin levels and glucose utilization. FK-614 treatment also decreased the daily insulin requirements (regular insulin, 0.18+/-0.01 vs 0.32+/-0.01 U/kg per day; and NPH insulin, 0.53+/-0.02 vs 0.89+/-0.04 U/kg per day; P<.001) to maintain fasting plasma glucose at approximately 10 mmol/L for 7 days before the experiments. We conclude that FK-614 treatment, at the dose used, improves peripheral glucose utilization because of an improvement in peripheral insulin sensitivity and a decrease in insulin clearance, but impairs hepatic insulin action in alloxan-induced diabetic dogs. The reason for the effects of FK-614 on hepatic glucose and insulin metabolism is unclear but they are both consistent with reports of hepatic steatosis by PPARgamma activation when unopposed by concomitant activation of PPARalpha.

Topics: Animals; Benzimidazoles; Blood Glucose; Blood Pressure; Diabetes Mellitus, Experimental; Dogs; Fatty Acids, Nonesterified; Glucagon; Glucose; Glucose Clamp Technique; Hyperinsulinism; Hypoglycemic Agents; Insulin; Insulin Resistance; Insulin, Isophane; Liver; Male; PPAR gamma; Tritium

Topics: Child; Circadian Rhythm; Diabetes Mellitus, Type 1; Feeding Behavior; Glycated Hemoglobin; Humans; Hyperinsulinism; Hypoglycemia; Hypoglycemic Agents; Insulin; Insulin, Isophane

Topics: Adrenal Cortex; Blood Chemical Analysis; Blood Glucose; Corticosterone; Hyperinsulinism; Hypoglycemia; Insulin; Insulin, Isophane; Insulin, Long-Acting; Pharmacology; Pituitary-Adrenal Function Tests; Protamines; Rats; Research