Splanchnic glucose uptake (SGU) plays a major role in the disposal of an oral glucose load (OGL). To investigate the effect of an elevated plasma free fatty acid (FFA) concentration on SGU in patients with type 2 diabetes, we measured SGU in eight diabetic patients (mean age 51 ؎ 4 years, BMI 29.3 ؎ 1.4 kg/m 2 , fasting plasma glucose 9.3 ؎ 0.7 mmol/l) during an intravenous Intralipid/heparin infusion and 7-10 days later during a saline infusion. SGU was estimated by the OGL insulin clamp method: subjects received a 7-h euglycemichyperinsulinemic clamp (insulin infusion rate ؍ 100 mU ⅐ m ؊2 ⅐ min ؊1 ), and a 75-g OGL was ingested 3 h after starting the insulin clamp. After glucose ingestion, the steady-state glucose infusion rate during the insulin clamp was decreased appropriately to maintain euglycemia. SGU was calculated by subtracting the integrated decrease in glucose infusion rate during the 4-h period after glucose ingestion from the ingested glucose load (75 g). 3-[ 3 H]glucose was infused during the 3-h insulin clamp before glucose ingestion to determine the rates of endogenous glucose production and glucose disappearance (R d ). Intralipid/heparin or saline infusion was initiated 2 h before the start of the OGL clamp. Plasma FFA concentrations were significantly higher during the OGL clamp with the intralipid/heparin infusion than with the saline infusion (2.5 ؎ 0.3 vs. 0.11 ؎ 0.02 mmol/l, P < 0.001). During the 3-h insulin clamp period before glucose ingestion, Intralipid/heparin infusion reduced R d (4.4 ؎ 0.3 vs. 5.3 ؎ 0.3 mg ⅐ kg ؊1 ⅐ min ؊1 , P < 0.01). During the 4-h period after glucose ingestion, SGU was significantly decreased during the intralipid/heparin versus saline infusion (30 ؎ 2 vs. 37 ؎ 2%, P < 0.01). In conclusion, an elevation in plasma FFA concentration impairs both peripheral and SGU in patients with type 2 diabetes. Diabetes 51:3043-3048, 2002 S planchnic glucose uptake (SGU) plays a major role in the disposal of an oral glucose load (OGL) (1-6). Hyperglycemia per se enhances SGU in proportion to the increase in plasma glucose concentration, such that the splanchnic glucose clearance remains unchanged (2). This mass action effect of hyperglycemia to augment SGU depends on maintained portal insulin levels (2). Insulin per se, in the absence of hyperglycemia, does not increase SGU (2,7).
Studies by DeFronzo et al. (3) and Adkins et al. (5) haveshown that the gastrointestinal route of glucose administration has a specific enhancing effect on SGU (3) and that after glucose ingestion, the fractional, as well as absolute uptake of glucose by the splanchnic tissues is significantly greater than the combined effects of hyperinsulinemia plus hyperglycemia created by intravenous glucose/insulin administration (2,5).Disturbances in free fatty acid (FFA) metabolism are characteristic in type 2 diabetic individuals (8 -11), who manifest day-long increased plasma FFA levels (11) and increased rates of lipolysis (8 -11). Elevated plasma FFA concentrations have been shown to impair glucose met...