Adequately Adapted Insulin Secretion and Decreased Hepatic Insulin Extraction Cause Elevated Insulin Concentrations in Insulin Resistant Non-Diabetic Adrenal Incidentaloma Patients

Background

Insulin-resistance is commonly found in adrenal incidentaloma (AI) patients. However, little is known about beta-cell secretion in AI, because comparisons are difficult, since beta–cell-function varies with altered insulin-sensitivity.

Objectives

To retrospectively analyze beta–cell function in non-diabetic AI, compared to healthy controls (CON).

Methods

AI (n=217, 34%males, 57±1years, body-mass-index:27.7±0.3kg/m²) and CON [n=25, 32%males, 56±1years, 26.7±0.8kg/m²] with comparable anthropometry (p≥0.31) underwent oral-glucose-tolerance-tests (OGTTs) with glucose, insulin, and C–peptide measurements. 1mg-dexamethasone-suppression-tests were performed in AI. AI were divided according to post–dexamethasone-suppression–test cortisol-thresholds of 1.8 and 5µg/dL into 3subgroups: pDexa<1.8µg/dL, pDexa1.8-5µg/dL and pDexa>5µg/dL. Using mathematical modeling, whole-body insulin-sensitivity [Clamp-like-Index (CLIX)], insulinogenic Index, Disposition Index, Adaptation Index, and hepatic insulin extraction were calculated.

Results

CLIX was lower in AI combined (4.9±0.2mg·kg^-1·min^-1), pDexa<1.8µg/dL (4.9±0.3) and pDexa1.8-5µg/dL (4.7±0.3, p<0.04 vs.CON:6.7±0.4). Insulinogenic and Disposition Indexes were 35%–97% higher in AI and each subgroup (p<0.008 vs.CON), whereas C–peptide–derived Adaptation Index, compensating for insulin-resistance, was comparable between AI, subgroups, and CON. Mathematical estimation of insulin–derived (insulinogenic and Disposition) Indexes from associations to insulin-sensitivity in CON revealed that AI-subgroups had ~19%-32% higher insulin-secretion than expectable. These insulin-secretion-index differences negatively (r=-0.45, p<0.001) correlated with hepatic insulin extraction, which was 13-16% lower in AI and subgroups (p<0.003 vs.CON).

Conclusions

AI-patients show insulin-resistance, but adequately adapted insulin secretion with higher insulin concentrations during an OGTT, because of decreased hepatic insulin extraction; this finding affects all AI-patients, regardless of dexamethasone-suppression-test outcome.     

Insulin in Invertebrates and Cyclostomes

It seems increasingly clear that insulin is a hormone that doesnot occur exclusively in vertebrates. Several independent reportsnow exist giving evidence of insulin production in the digestivetissues of both deuterostomian and protostomian invertebrates.Cells with some light-microscopical and ultrastructural characteristicsof vertebrate B-cells have also been observed. Recently, evidencehas been obtained that insulin can act as a hypoglycemic hormone,promoting glycogen synthesis, also in a protostomian invertebrate,the gastropod mollusc, Strophocheilus oblongus. The endocrine pancreas of the cyclostomes occupies a key positionin the comparative endocrinology of the islet parenchyma andin the evolution of insulin production. It may represent anevolutionary link between the presumably gut-connected dispersedinsulin-producing cells of deuterostomian invertebrates andthe pancreatic islets of gnathostomian vertebrates. This hypothesiswas supported by the fact that cells with light-microscopicaland ultrastructural similarities to the islet B-cells were observedin the bile duct mucosa of the hagfish, Myxine glutinosa. However,immunofluorescent studies with antisera against human insulinand C-peptide did not show any immunoreactive material outsidethe B-cells of the endocrine pancreas. Particular attentionwas paid to elucidate the biological significance of the largecystic cavities that are so typical for the cyclostomian isletparenchyma. The working hypothesis that they may contain storedinsulin, proinsulin (or even "proto-proinsulin") was not supportedby immunofluorescence, autoradiographic, or ultrastructuralinvestigations, nor by proinsulin assays. It is possible thathagfish islet B-cells contain zinc, despite the fact that theamino acid residue in B₁₀-position is aspartic acid insteadof histidine. The biosynthesis of hagfish insulin shows a patternsimilar to that in gnathostomes. Its rate is related to theambient temperature and at 11 C the conversion of proinsulinto insulin lasts several days.     

Insulin and memory in Lymnaea

The pond snail, Lymnaea stagnalis, is capable of learning conditioned taste aversion (CTA) and consolidating this CTA into long-term memory (LTM). The DNA microarray experiments showed that some of molluscan insulin-related peptides (MIPs) were up-regulated in snails exhibiting CTA-LTM. On the other hand, the electrophysiological experiments showed that application of secretions from the MIPs-containing cells evoked long-term potentiation (LTP) at the synapses between the cerebral giant cell (a key interneuron for CTA) and the B1 motoneuron (a buccal motoneuron). We thus hypothesized that MIPs and MIP receptors play an important role at the synapses, probably underlying the CTA-LTM consolidation process. To examine this hypothesis, we applied the antibody, which recognizes the binding site of mammalian insulin receptors and is thought to cross-react MIP receptors, to the Lymnaea CNS. Our present data showed that an application of the antibody for insulin receptors to the isolated CNS blocked LTP, and that an injection of the antibody into the Lymnaea abdominal cavity inhibited LTM consolidation, but not CTA formation.     

Optimized Basal-Bolus Insulin Regimens in Type 1 Diabetes: Insulin Glulisine Versus Regular Human Insulin in Combination with Basal Insulin Glargine

ObjectiveTo compare the efficacy and safety of insulin glulisine (GLU), a new rapid-acting insulin analogue, injected 0 to 15 minutes before or immediately after meals, with regular human insulin (RHI), injected 30 to 45 minutes before meals.MethodsPatients with type 1 diabetes (N = 860) received once-daily insulin glargine and subcutaneous injections of either GLU (premeal or postmeal) or premeal RHI in this open-label, randomized, controlled, multicenter, parallel-group, 12-week study.ResultsBaseline to endpoint changes in mean glycated hemoglobin (as A1c equivalents) (A1c) occurred in the premeal GLU, postmeal GLU, and premeal RHI groups (-0.26%, -0.11%, and -0.13%, respectively). The reduction in A1c was greater for the premeal GLU group in comparison with the RHI group (P = 0.02) and the post-meal GLU group (P = 0.006); no significant between-treatment difference was found for postmeal GLU versus RHI. Overall, blood glucose profiles were similar in all 3 treatment groups but were significantly lower for premeal GLU 2-hour postbreakfast measurements (premeal versus postmeal GLU, P = 0.0017; premeal GLU versus RHI, P = 0.0001) and 2-hour postdinner measurements (premeal GLU versus RHI, P = 0.0001; premeal versus postmeal GLU, P = 0.0137). Severe hypoglycemic episodes were comparable for premeal GLU, postmeal GLU, and pre-meal RHI groups (8.4%, 8.4%, and 10.1%, respectively). Body weight increased (+ 0.3 kg) in the RHI and premeal GLU groups; however, weight decreased in the postmeal GLU group (-0.3 kg; between-treatment difference, P = 0.03).ConclusionBetter A1c reductions were obtained with premeal GLU, but postmeal administration of GLU was as safe and effective as premeal GLU or RHI in combination with insulin glargine and was not associated with weight gain. (Endocr Pract. 2005;11:11-17)     

牛胰岛素的酰胺化反应及其六酰胺产物的分离及鉴定

牛胰岛素用1％三氟化硼甲醇溶液反应后所得六甲酯与饱和氨甲醇溶液反应,在室温下约经144小时可完全酰胺化。反应过程用红外光谱及酰胺含量分析测定。所得酰胺化粗产品经Sephadex G-75凝胶层析可以将胰岛素六酰胺化合物从其聚合物中分离提纯。由红外光谱、紫外光谱及圆二色散光谱测定表明:牛胰岛素的六酰胺化合物的构象与胰岛素有很大不同,其生物活性也丧失殆尽。     

Insulin and aging

In invertebrates, signaling pathways homologous to mammalian insulin and insulin-like growth factor (IGF-1) signal transduction have a major role in the control of longevity. There are numerous indications that these pathways also influence aging in mammals, but separating the role of insulin from the effects of IGF-1 and growth hormone (GH) is difficult. In mice, selective disruption of the insulin receptor in the adipose tissue extends longevity. Increases in lifespan were also reported in mice with deletion of insulin receptor substrate 1 (IRS1) in whole body or IRS2 only in the brain. GH deficiency or resistance in mutant mice leads to hypoinsulinemia and enhanced insulin sensitivity along with remarkably extended longevity. These characteristics resemble animals subjected to calorie restriction. Studies of physiological characteristics and polymorphisms of insulin-related genes in exceptionally long-lived people suggest a role of insulin signaling in the control of human aging.     

Insulin Injection and Hemolymph Extraction to Measure Insulin Sensitivity in Adult Drosophila melanogaster

Conserved nutrient sensing mechanisms exist between mammal and fruit fly where peptides resembling mammalian insulin and glucagon, respectively function to maintain glucose homeostasis during developmental larval stages ^1,2. Studies on largely post-mitotic adult flies have revealed perturbation of glucose homeostasis as the result of genetic ablation of insulin-like peptide (ILP) producing cells (IPCs) ³. Thus, adult fruit flies hold great promise as a suitable genetic model system for metabolic disorders including type II diabetes. To further develop the fruit fly system, comparable physiological assays used to measure glucose tolerance and insulin sensitivity in mammals must be established. To this end, we have recently described a novel procedure for measuring oral glucose tolerance response in the adult fly and demonstrated the importance of adult IPCs in maintaining glucose homeostasis ^4,5. Here, we have modified a previously described procedure for insulin injection ⁶ and combined it with a novel hemolymph extraction method to measure peripheral insulin sensitivity in the adult fly. Uniquely, our protocol allows direct physiological measurements of the adult fly''s ability to dispose of a peripheral glucose load upon insulin injection, a methodology that makes it feasible to characterize insulin signaling mutants and potential interventions affecting glucose tolerance and insulin sensitivity in the adult fly.Download video file.^{(37M, mov)}     

胰岛素对β细胞胰岛素分泌的反馈影响

目的：探讨不同浓度外源性胰岛素在不同浓度葡萄糖情况下对β TC-3细胞胰岛素分泌的影响。方法：取对数生长期的13TC3细胞分三组,即低糖组、中糖组、高糖组（葡萄糖浓度分别取1．0mmol／L、3．Ommoi／L、20．Ommol／L）。每组分0、5、10、15、100、500、5000和50000μU／ml胰岛素八个亚组（其中0μU／ml作为对照组）。刺激10分钟后取上清液测C肽。结果：在高糖组中,C肽分泌量无明显差异;在中糖组中,10μU／ml和15μU／ml两组相对对照组C肽分泌量显著增加,50000μU／ml组C肽分泌量则相对对照组出现减少,其余3个亚组无明显改变;在低糖组中,c肽分泌量除5000μU／ml组减少外。其它亚组C肽分泌量无明显差畀。结论：胞外胰岛素在适宜葡萄糖浓度时,对BTC3细胞胰岛素分泌的反馈影响呈剂量依赖关系。