Elsevier

Metabolism

Volume 36, Issue 11, November 1987, Pages 1091-1095
Metabolism

Insulin action in non-insulin-dependent diabetes mellitus: The relationship between hepatic and extrahepatic insulin resistance and obesity

https://doi.org/10.1016/0026-0495(87)90031-XGet rights and content

Abstract

To determine the contribution of obesity to the insulin resistance of non-insulin-dependent diabetes mellitus, insulin dose response curves for suppression of glucose production and stimulation of glucose utilization were generated in lean and obese diabetic patients and compared to those observed in weight-matched nondiabetic subjects. Glucose utilization during 0.4, 1.0, and 10.0 mU/kg × min insulin infusions (producing insulin concentrations ranging from ∼50 to 2,000 μU/mL) was lower (p < .02 to .001) in lean and obese diabetic patients compared to weight-matched nondiabetic subjects indicating insulin resistance. Glucose utilization was not correlated with obesity in the diabetic subjects. Suppression of glucose production was impaired (P < .03 and .001) in both the lean and obese diabetic subjects at physiologic but not supraphysiologic insulin concentrations. We conclude that patients with NIDDM have both hepatic and extrahepatic insulin resistance, the severity of which appears to be independent of the degree of obesity.

References (37)

  • L Harrison et al.

    Insulin sensitivity of adipose tissue in vitro and the response to exogenous insulin in obese human subjects

    Metabolism

    (1976)
  • A Keys et al.

    Indices of relative weight and obesity

    J Chronic Dis

    (1972)
  • S Sasson et al.

    Substrate regulation of glucose transport in rate skeletal muscle

    J Biol Chem

    (1986)
  • L Salans et al.

    Glucose metabolism and the response to insulin by human adipose tissue in spontaneous and experimental obesity: Effects of dietary composition and adipose cell size

    J Clin Invest

    (1974)
  • R DeFronzo et al.

    Insulin binding to monocytes and insulin action in human obesity, starvation and feeding

    J Clin Invest

    (1978)
  • O Kolterman et al.

    Mechanisms of insulin resistance in human obesity evidence for receptor and postreceptor defects

    J Clin Invest

    (1980)
  • J Reckless et al.

    Peripheral resistance to the cellular action of insulin in obese diabetic subjects in vivo

    Clin Sci

    (1980)
  • J Bolinder et al.

    Postreceptor defects causing insulin resistance in normoinsulinemic noninsulin-dependent diabetes mellitus

    Diabetes

    (1982)
  • Y Harano et al.

    Glucose, insulin and somatostatin infusion for the determination of insulin sensitivity

    J Clin Endocrinol Metab

    (1977)
  • H Beck-Nielsen et al.

    Normalization of the insulin sensitivity and the cellular insulin binding during treatment of obese diabetics for one year

    Acta Endocrinol

    (1979)
  • M Nagulesparan et al.

    Increased insulin resistance in obese, glucose-intolerant southwestern American Indians: evidence for a defect not explained by obesity

    J Clin Endocrinol Metab

    (1980)
  • R Rizza et al.

    Mechanism and significance of insulin resistance in noninsulin-dependent diabetes mellitus

    Diabetes

    (1981)
  • O Kolterman et al.

    Receptor and postreceptor defects contribute to the insulin resistance in noninsulin-dependent diabetes mellitus

    J Clin Invest

    (1981)
  • G Reaven et al.

    How insulin resistant are patients with noninsulin-dependent diabetes mellitus

    J Clin Endocrinol Metab

    (1985)
  • R DeFronzo et al.

    Effects of insulin on peripheral and splanchnic glucose metabolism in noninsulin-dependent (type II) diabetes mellitus

    J Clin Invest

    (1985)
  • R DeFronzo et al.

    Insulin sensitivity and insulin binding to monocytes in maturity-onset diabetes

    J Clin Invest

    (1979)
  • R DeFronzo et al.

    Hepatic and peripheral insulin resistance: A common feature of type II (noninsulin-dependent) and type I (insulin-dependent) diabetes mellitus

    Diabetologia

    (1982)
  • G Reaven et al.

    Comparison of insulin secretion and in vivo insulin action in nonobese and moderately obese individuals with noninsulin-dependent diabetes mellitus

    Diabetes

    (1982)
  • Cited by (0)

    Supported by UPHS Grant Nos. AM29953 and RR00585, and the Mayo Foundation.

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