A B S T R A C T The role of glucagon in the metabolic adaptation to prolonged fasting in man has been examined. Plasma immunoreactive glucagon was determined during 6-wk fasts and during infusion of exogenous glucagon using an assay which minimized nonpancreatic immunoreactivity.Plasma glucagon concentrations rose twofold to a peak on the 3rd day of fasting and then declined thereafter to a level maintained at or above postabsorptive. Insulin concentration declined to a plateau by the 3rd day. Thus a persisting altered relationship of glucagon and insulin concentrations characterized the fasted state. A synergism of low insulin and relative or absolute elevation of glucagon levels is viewed as a hormonal mechanism controlling the rate of hepatic substrate extraction for gluconeogenesis.Glucagon was infused systemically into 4-6-wk fasted subjects at three dose levels. A marked sensitivity of individual plasma free amino acids to the induced elevations of plasma glucagon within the physiologic range was demonstrated. At higher concentrations, equivalent to those present in the portal vein, stimulation of hepatic gluconeogenesis occurred, and the effects on glucose, insulin, and growth hormone levels and on ketone metabolism were induced.

The metabolic response to exercise in obese postabsorptive noninsulin-dependent diabetics was compared to that of obese nondiabetics. Exercise consisted of 45 min on a cycle ergometer at 60% maximum oxygen consumption. Six diabetic subjects were studied during oral hypoglycemic therapy and four on diet alone. The sulfonylurea therapy had no effect on the response. Glycemia was elevated at rest in both diabetic subgroups (192 +/- 24 mg/dl for diet alone, 226 +/- 36 mg/dl for sulfonylurea treatment) and a similar fall (35 and 37 mg/dl, respectively) occurred with exercise. In control subjects, glycemia was 86 +/- 4 mg/dl and did not change with exercise. In the diabetics at rest, glucose production was elevated (220 +/- 25 mg/min), whereas the metabolic clearance of glucose was suppressed. During exercise the increase in glucose utilization was similar to that in controls, but glucose production failed to increase significantly, thus accounting for the decline in plasma glucose. At rest, plasma immunoreactive insulin (IRI) was elevated to 0.90 ng/ml in the controls and decreased to 0.65 ng/ml with exercise. In the diabetics IRI was similarly elevated (0.89 ng/ml) but failed to decrease normally with exercise. Lactate, pyruvate, alanine, and free fatty acids increased similarly in diabetics and controls, whereas the increase in 3-hydroxybutyrate during recovery was less in diabetics. The sustained insulinemia, the basal overproduction of glucose, and hyperglycemia itself may all contribute to the observed differences in glucose flux during exercise in noninsulin-dependent diabetics.

A B S T R A C T Arterio-venous differences across forearm muscle in man in both prolonged starvation and in the postabsorptive state, show an uptake of glutamate and a relatively greater production of glutamine. Splanchnic arteriovenous differences in the postabsorptive state show a net uptake of glutamine and lesser rate of glutamate production. These data suggest that muscle is a major site of glutamine synthesis in man, and that the splanchnic bed is a site of its removal. The relative roles of liver and other tissues in the splanchnic circuit were not directly assessed, only the net balance. These data in man are in conflict with most previous studies in other species attributing the major proportion of glutamine production to the liver and, pari passu, to the splanchnic bed. INTRODUCTIONDuring starvation, muscle protein catabolism provides amino acid substrate for both hepatic and renal gluconeogenesis. Recent studies have emphasized the central role of alanine in hepatic amino acid extraction (1) and amino acid release from muscle (2). This report includes data on peripheral and splanchnic metabolism of glutamate and glutamine in man, and, in contrast to current opinion as reviewed by Lotspeich (3), suggests that under physiologic circumstances, muscle in man is an important site of glutamine production, and the splanchnic bed is a site of its removal. Hence glutamine in man appears to be as prominent a vehicle as alanine for both glucogenic precursor and nitrogen fluxes from muscle to the splanchnic bed and to the kidney.

To investigate the effect of intense exercise on immune function, 12 healthy males (26 +/- 1 yr) underwent cycle exercise to exhaustion at 80% maximum work load. One hour later, six of the subjects underwent a second identical bout. Blood was drawn preexercise (C), at exhaustion (Ex-1, Ex-2), and at 1 h of recovery (Rec-1, Rec-2). At Ex-1 and Ex-2, total leukocytes (monocytes, neutrophils, and lymphocytes) increased significantly (P less than 0.05), and all returned to C levels by Rec-1 except lymphocytes, which were lower than at C. At Rec-2 total leukocytes remained higher (P less than 0.05) than at C, primarily because of elevated neutrophil counts. Phenotype analysis indicated a 2.5-fold increase in CD16+ (natural killer) cells at Ex-1 and a decrease primarily in CD4+ (T-helper) cells. All phenotype changes returned to C levels at Rec-1. At Ex-1 the in vitro mitogenic response to concanavalin A, phorbol myristate acetate + ionomycin, phytohemagglutinin, and pokeweed mitogen decreased (P less than 0.05) but returned to levels not different from C at Rec-1. Both the in vitro percent specific lysis of a target natural killer cell (K562) and the lytic activity per cell increased (P less than 0.05) in peripheral mononuclear cells at Ex-1, returning to C levels at Rec-1. The total leukocyte counts with exercise were significantly correlated with plasma epinephrine concentration, and a causal effect is thus possible. Such acute changes in numbers and function of circulating cells of the immune system may possibly have functional and clinical correlates.

In prolonged fasting, the brain derives a large portion of its oxidative energy from the ketone bodies, beta-hydroxybutyrate and acetoacetate, thereby reducing whole body glucose consumption. Energy substrate utilization differs regionally in the brain of fasting rat, but comparable information has hitherto been unavailable in humans. We used positron emission tomography (PET) to study regional brain glucose and oxygen metabolism, blood flow, and blood volume in four obese subjects before and after a 3-wk total fast. Whole brain glucose utilization fell to 54% of control (postabsorptive) values (P less than 0.002). The whole brain rate constant for glucose tracer phosphorylation fell to 51% of control values (P less than 0.002). Both parameters decreased uniformly throughout the brain. The 2-fluoro-2-deoxy-D-glucose lumped constant decreased from a control value of 0.57 to 0.43 (P less than 0.01). Regional blood-brain barrier transfer coefficients for glucose tracer, regional oxygen utilization, blood flow, and blood volume were unchanged.