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Role of Basal Insulin in the Regulation of Protein Kinetics and Energy Metabolism in Septic Patients
Author(s) -
Zhang XiaoJun,
Kunkel Kelly R.,
Jahoor Farook,
Wolfe Robert R.
Publication year - 1991
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607191015004394
Subject(s) - somatostatin , medicine , glucagon , insulin , endocrinology , basal (medicine) , leucine , chemistry , metabolism , basal metabolic rate , carbohydrate , biology , biochemistry , amino acid
We have investigated the role of basal insulin concentration on leucine kinetics (determined by means of 1‐[ 13 C]leucine) and energy metabolism (determined by indirect calorimetry) in eight septic patients by reducing insulin (and glucagon) secretion by somatostatin infusion. Basal glucagon concentration was elevated (744 ± 381 pg/mL), and insulin concentration was normal (10 ± 4 μU/mL). Basal resting energy expenditure (REE) was 151 ± 8% that of predicted basal energy expenditure, and leucine appearance (Ra), oxidation, and nonoxidative disposal rates were all elevated above the normal ranges. Somatostatin infusion reduced insulin concentration by 52% and glucagon concentration by 64%. This resulted in a significant increase in the rate of leucine oxidation from 0.96 ± 0.08 to 1.18 ± 0.14 μmol/kg/min ( p < 0.01), and nonoxidative leucine disposal decreased from 2.95 ± 0.18 to 2.67 ± 0.17 μmol/kg/min ( p < 0.01). Somatostatin infusion also caused significant increases in REE and fat oxidation from 1310 ± 100 to 1505 ± 128 kcal/m 2 /day ( p < 0.05) and from 1.72 ± 0.24 to 2.41 ± 0.41 mg/kg/min, respectively, and a slight decrease of carbohydrate oxidation from 1.51 ± 0.49 to 1.31 ± 0.49 mg/kg/min. These metabolic responses can be attributed to the reduction in insulin concentration, because they are in the opposite direction of changes that would occur as a consequence of a reduction in glucagon concentration. We conclude that the basal insulin plays an important role in attenuating net protein loss and energy expenditure. ( Journal of Parenteral and Enteral Nutrition 15 :394–399, 1991)