Abstract
Investigative data have suggested that the extrapancreatic actions of the sulfonylureas may be paramount in their chronic antidiabetic action. The present study examines the effects of chronic sulfonylurea treatment on in vivo insulin action. Peripheral insulin levels, hepatic glucose production (Ra), and overall glucose disposal (Rd) were studied in six awake, normal dogs given both 0.5 and 1.0 mU/kg per min pork insulin for 2.5 h. This produces stable hyperinsulinemia from 15 to 150 min. Fasting euglycemia was held constant by the glucose clamp technique and averaged 99% basal glucose in all studies. Ra and Rd were determined from infusion of [3-(3)H]glucose, begun 90 min prior to insulin infusion. 10 mg of the sulfonylurea glipizide, was given daily to the test animals for the 10 to 20 d following appropriate control studies, then was withheld for 24 h, and the dogs were restudied. Glipizide treatment did not significantly alter basal glucose turnover, Ra, mean glucose values, or mean insulin levels as determined by radioimmunoassay. Increase in Rd above basal glucose turnover in response to insulin (delta Rd) was significantly (P less than 0.05) increased by glipizide treatment at both insulin dosage levels (paired analysis). At 1.0 mU/kg per min insulin, delta Rd rose from 2.6 mg/kg per min before glipizide to 6.5 mg/kg per min after glipizide treatment. At 0.5 mU/kg per min insulin, delta Rd went from 1.1 mg/kg per min before glipizide to 2.2 mg/kg per min after glipizide treatment. Glipizide treatment doubled the effects of insulin on Rd, while showing no significant effect upon insulin suppression of Ra. We conclude that a significant extrapancreatic chronic action of glipizide lies in its ability to selectively potentiate Rd.
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Selected References
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- Beck-Nielsen H., Pedersen O., Lindskov H. O. Increased insulin sensitivity and cellular insulin binding in obese diabetics following treatment with glibenclamide. Acta Endocrinol (Copenh) 1979 Mar;90(3):451–462. doi: 10.1530/acta.0.0900451. [DOI] [PubMed] [Google Scholar]
- Beck-Nielsen H., Pedersen O., Sørensen N. S. Effects of dietary changes on cellular insulin binding and in vivo insulin sensitivity. Metabolism. 1980 May;29(5):482–487. doi: 10.1016/0026-0495(80)90174-2. [DOI] [PubMed] [Google Scholar]
- Blumenthal S. A. Potentiation of the hepatic action of insulin by chlorpropamide. Diabetes. 1977 May;26(5):485–489. doi: 10.2337/diab.26.5.485. [DOI] [PubMed] [Google Scholar]
- COLWELL A. R., Jr POTENTIATION OF INSULIN ACTION ON THE LIVER BY TOLBUTAMIDE. Metabolism. 1964 Nov;13:1310–1317. doi: 10.1016/0026-0495(64)90150-7. [DOI] [PubMed] [Google Scholar]
- CRAIG J. W., DRUCKER W. R., MILLER M., WOODWARD H., Jr, MOLZAHN V. A comparison of the influence of tolbutamide and small doses of insulin on the splanchnic output and peripheral uptake of glucose in man. Ann N Y Acad Sci. 1959 Mar 30;74(3):537–547. doi: 10.1111/j.1749-6632.1959.tb39578.x. [DOI] [PubMed] [Google Scholar]
- Cowan J. S., Hetenyi G., Jr Glucoregulatory responses in normal and diabetic dogs recorded by a new tracer method. Metabolism. 1971 Apr;20(4):360–372. doi: 10.1016/0026-0495(71)90098-9. [DOI] [PubMed] [Google Scholar]
- Crettaz M., Jeanrenaud B. Postreceptor alterations in the states of insulin resistance. Metabolism. 1980 May;29(5):467–473. doi: 10.1016/0026-0495(80)90172-9. [DOI] [PubMed] [Google Scholar]
- Davies P. J., Davies D. R., Levitzki A., Maxfield F. R., Milhaud P., Willingham M. C., Pastan I. H. Transglutaminase is essential in receptor-mediated endocytosis of alpha 2-macroglobulin and polypeptide hormones. Nature. 1980 Jan 10;283(5743):162–167. doi: 10.1038/283162a0. [DOI] [PubMed] [Google Scholar]
- DeFronzo R. A., Tobin J. D., Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol. 1979 Sep;237(3):E214–E223. doi: 10.1152/ajpendo.1979.237.3.E214. [DOI] [PubMed] [Google Scholar]
- Feinglos M. N., Lebovitz H. E. Sulphonylureas increase the number of insulin receptors. Nature. 1978 Nov 9;276(5684):184–185. doi: 10.1038/276184a0. [DOI] [PubMed] [Google Scholar]
- Feldman J. M., Lebovitz H. E. An insulin dependent effect of chronic tolbutamide administration on the skeletal muscle carbohydrate transport system. Diabetes. 1969 Feb;18(2):84–95. doi: 10.2337/diab.18.2.84. [DOI] [PubMed] [Google Scholar]
- Feldman J. M., Lebovitz H. E. Appraisal of the extrapancreatic actions of sulfonylureas. Arch Intern Med. 1969 Mar;123(3):314–322. [PubMed] [Google Scholar]
- Felig P., Wahren J. Influence of endogenous insulin secretion on splanchnic glucose and amino acid metabolism in man. J Clin Invest. 1971 Aug;50(8):1702–1711. doi: 10.1172/JCI106659. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kahn C. R. Role of insulin receptors in insulin-resistant states. Metabolism. 1980 May;29(5):455–466. doi: 10.1016/0026-0495(80)90171-7. [DOI] [PubMed] [Google Scholar]
- Kimmerling G., Javorski C., Olefsky J. M., Reaven G. M. Locating the site(s) of insulin resistance in patients with nonketotic diabetes mellitus. Diabetes. 1976 Aug;25(8):673–678. doi: 10.2337/diab.25.8.673. [DOI] [PubMed] [Google Scholar]
- Lebovitz H. E., Feinglos M. N., Bucholtz H. K., Lebovitz F. L. Potentiation of insulin action: a probable mechanism for the anti-diabetic action of sulfonylurea drugs. J Clin Endocrinol Metab. 1977 Sep;45(3):601–604. doi: 10.1210/jcem-45-3-601. [DOI] [PubMed] [Google Scholar]
- Lebovitz H. E., Feinglos M. N. Sulfonylurea drugs: mechanism of antidiabetic action and therapeutic usefulness. Diabetes Care. 1978 May-Jun;1(3):189–198. doi: 10.2337/diacare.1.3.189. [DOI] [PubMed] [Google Scholar]
- Lebovitz H. E., Feinglos M. N. Therapy of insulin-independent diabetes mellitus: general considerations. Metabolism. 1980 May;29(5):474–481. doi: 10.1016/0026-0495(80)90173-0. [DOI] [PubMed] [Google Scholar]
- MADISON L. L., COMBES B., ADAMS R., STRICKLAND W. The physiological significance of the secretion of endogenous insulin into the portal circulation. III. Evidence for a direct immediate effect of insulin on the balance of glucose across the liver. J Clin Invest. 1960 Mar;39:507–522. doi: 10.1172/JCI104065. [DOI] [PMC free article] [PubMed] [Google Scholar]
- MADISON L. L., COMBES B., UNGER R. H., KAPLAN N. The relationship between the mechanism of action of the sulfonylureas and the secretion of insulin into the portal circulation. Ann N Y Acad Sci. 1959 Mar 30;74(3):548–556. doi: 10.1111/j.1749-6632.1959.tb39579.x. [DOI] [PubMed] [Google Scholar]
- McGuire E. A., Helderman J. H., Tobin J. D., Andres R., Berman M. Effects of arterial versus venous sampling on analysis of glucose kinetics in man. J Appl Physiol. 1976 Oct;41(4):565–573. doi: 10.1152/jappl.1976.41.4.565. [DOI] [PubMed] [Google Scholar]
- Olefsky J. M., Reaven G. M. Decreased insulin binding to lymphocytes from diabetic subjects. J Clin Invest. 1974 Dec;54(6):1323–1328. doi: 10.1172/JCI107878. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Olefsky J. M., Reaven G. M. Effects of sulfonylurea therapy on insulin binding to mononuclear leukocytes of diabetic patients. Am J Med. 1976 Jan;60(1):89–95. doi: 10.1016/0002-9343(76)90537-4. [DOI] [PubMed] [Google Scholar]
- Olefsky J. M., Reaven G. M. Insulin binding in diabetes. Relationships with plasma insulin levels and insulin sensitivity. Diabetes. 1977 Jul;26(7):680–688. doi: 10.2337/diab.26.7.680. [DOI] [PubMed] [Google Scholar]
- Prince M. J., Olefsky J. M. Direct in vitro effect of a sulfonylurea to increase human fibroblast insulin receptors. J Clin Invest. 1980 Sep;66(3):608–611. doi: 10.1172/JCI109894. [DOI] [PMC free article] [PubMed] [Google Scholar]
- RECANT L., FISCHER G. L. Studies on the mechanism of tolbutamide hypoglycemia in animal and human subjects. Ann N Y Acad Sci. 1957 Jul 10;71(1):62–70. [PubMed] [Google Scholar]
- REICHARD G. A., Jr, JACOBS A. G., FRIEDMANN B., KIMBEL P. R., HOCHELLA N. J., WEINHOUSE S. Effects of insulin and tolbutamide on production and utilization of blood sugar. Metabolism. 1959 Jul 2;8(4 Pt 2):486–493. [PubMed] [Google Scholar]
- Radziuk J., Norwich K. H., Vranic M. Measurement and validation of nonsteady turnover rates with applications to the inulin and glucose systems. Fed Proc. 1974 Jul;33(7):1855–1864. [PubMed] [Google Scholar]
- Reaven G. M., Bernstein R., Davis B., Olefsky J. M. Nonketotic diabetes mellitus: insulin deficiency or insulin resistance? Am J Med. 1976 Jan;60(1):80–88. doi: 10.1016/0002-9343(76)90536-2. [DOI] [PubMed] [Google Scholar]
- Reaven G. M. Insulin-independent diabetes mellitus: metabolic characteristics. Metabolism. 1980 May;29(5):445–454. doi: 10.1016/0026-0495(80)90170-5. [DOI] [PubMed] [Google Scholar]
- SCHAMBYE P., TARDING F. Changes induced by insulin and tolbutamide in the glucose output of the liver. Ann N Y Acad Sci. 1959 Mar 30;74(3):557–569. doi: 10.1111/j.1749-6632.1959.tb39580.x. [DOI] [PubMed] [Google Scholar]
- STEELE R. Influences of glucose loading and of injected insulin on hepatic glucose output. Ann N Y Acad Sci. 1959 Sep 25;82:420–430. doi: 10.1111/j.1749-6632.1959.tb44923.x. [DOI] [PubMed] [Google Scholar]
- Saccà L., Cryer P. E., Sherwin R. S. Blood glucose regulates the effects of insulin and counterregulatory hormones on glucose production in vivo. Diabetes. 1979 Jun;28(6):533–536. doi: 10.2337/diab.28.6.533. [DOI] [PubMed] [Google Scholar]
- Saccà L., Sherwin R., Hendler R., Felig P. Influence of continuous physiologic hyperinsulinemia on glucose kinetics and counterregulatory hormones in normal and diabetic humans. J Clin Invest. 1979 May;63(5):849–857. doi: 10.1172/JCI109384. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schlessinger J., Shechter Y., Willingham M. C., Pastan I. Direct visualization of binding, aggregation, and internalization of insulin and epidermal growth factor on living fibroblastic cells. Proc Natl Acad Sci U S A. 1978 Jun;75(6):2659–2663. doi: 10.1073/pnas.75.6.2659. [DOI] [PMC free article] [PubMed] [Google Scholar]
- TARDING F., SCHAMBYE P. The action of sulphonylureas and insulin on the glucose output from the liver of normal dogs. Endokrinologie. 1958 Jul;36(3-4):222–228. [PubMed] [Google Scholar]
- Zinman B., Ogilvie R. I. The acute effects of tolbutamide on forearm metabolism. J Clin Endocrinol Metab. 1972 Aug;35(2):299–306. doi: 10.1210/jcem-35-2-299. [DOI] [PubMed] [Google Scholar]