The effect of tramadol on the plasma glucose level of streptozotocin (STZ)-induced diabetic rats was investigated. A dose-dependent lowering of plasma glucose was seen in the fasting STZ-induced diabetic rats 30 min after intravenous injection of tramadol. This effect of tramadol was abolished by pretreatment with naloxone or naloxonazine at doses sufficient to block opioid -receptors. However, response to tramadol was not changed in STZ-induced diabetic rats receiving p-chlorophenylalanine at a dose sufficient to deplete endogenous 5-hydroxytrptamine (5-HT). Therefore, mediation of 5-HT in this action of tramadol is ruled out. In isolated soleus muscle, tramadol enhanced the uptake of radioactive glucose in a concentration-dependent manner. The stimulatory effects of tramadol on glycogen synthesis were also seen in hepatocytes isolated from STZ-induced diabetic rats. The blockade of these actions by naloxone and naloxonazine indicated the mediation of opioid -receptors. The mRNA and protein levels of the subtype 4 form of glucose transporter in soleus muscle were increased after repeated treatments for 4 days with tramadol in STZ-induced diabetic rats. Moreover, similar repeated treatments with tramadol reversed the elevated mRNA and protein levels of phosphoenolpyruvate carboxykinase in the liver of STZinduced diabetic rats. These results suggest that activation of opioid -receptors by tramadol can increase the utilization of glucose and/or decrease hepatic gluconeogenesis to lower plasma glucose in diabetic rats lacking insulin. Diabetes 50: [2815][2816][2817][2818][2819][2820][2821] 2001 U nlike the analgesic effects of opioids, their effects on glucose metabolism in diabetes have received little attention. In diabetic patients, -endorphin stimulates insulin secretion (1). Also, -endorphin is known to be involved in plasma glucose homeostasis (2,3). Opioid receptors in the pancreas have been investigated for this regulation of plasma glucose (4,5). However, the effect of opioids on glucose homeostasis does not depend entirely on insulin. In our previous study (6), we found that -endorphin is also responsible for the reduction of plasma glucose during cold exposure in streptozotocin (STZ)-induced diabetic rats, which were used as a type 1 diabetes model. Actually, injection of exogenous -endorphin lowered plasma glucose in STZ-induced diabetic rats (6). Moreover, we demonstrated that loperamide, an agonist of opioid -receptors, could lower plasma glucose in STZ-induced diabetic rats (7). Thus, it has been shown that activation of opioid -receptors may produce a plasma glucose-lowering effect in diabetic rats lacking insulin. Clinically, tramadol has widely been used as an analgesic through activation of opioid -receptors (8 -11) and others (9). In the present study, we investigated the effect of tramadol on plasma glucose and characterized the role of opioid -receptors in the action of tramadol during the absence of insulin, both in vivo and in vitro. We also examined the influence of repeated treatmen...