title: The effect of insulin on the leg and splanchnic balance of glucose and gluconeogenic substrates after cardiac surgery.
abstract: The effect of insulin and glucose infusion on the leg and splanchnic balance of glucose and the gluconeogenic substrates lactate, pyruvate, alanine and glycerol was studied in 13 patients directly after cardiac surgery. Insulin was infused continuously at a rate of 1.0 Unit/kg/hr during 1 hour. Sixteen patients served as a control group and received no insulin and glucose infusion. A significant increase in arterial lactate concentration in both the control group (from 1.40 +/- 0.19 to 1.68 +/- 0.24 mmol/l p less than 0.01) and the insulin group (from 1.58 +/- 0.27 to 2.07 +/- 0.22 mmol/l, p less than 0.05) was observed. The arterial pyruvate concentration was significantly increased (from 0.075 +/- 0.019 to 0.105 +/- 0.021 mmol/l, p less than 0.01) and glycerol was significantly decreased (from 0.15 +/- 0.03 to 0.12 +/- 0.03 mmol/l, p less than 0.05) during the insulin and glucose infusion. The alanine concentration was unchanged in both groups. Insulin and glucose infusion was followed by an increased leg uptake of glucose (from 0.15 +/- 0.14 to 1.06 +/- 0.16 mmol/min/100 ml, p less than 0.05), and by a changed splanchnic glucose balance (from -8.2 +/- 2.8 to +4.0 +/- 1.2 mmol/kg/min, p less than 0.01). A net leg release and at the same time a net splanchnic uptake of all gluconeogenic substrates was observed. The insulin and glucose infusion did not significantly change either the splanchnic balance or the leg balance of the gluconeogenic substrates.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Uppsala, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Nilsson
authors.forename: R
authors.initials: R
authors.lastname: Ekroth
authors.forename: I
authors.initials: I
authors.lastname: Milocco
authors.forename: N J
authors.initials: NJ
authors.lastname: Nilsson
authors.forename: K G
authors.initials: KG
authors.lastname: Sabel
authors.forename: S
authors.initials: S
authors.lastname: Svensson
authors.forename: E
authors.initials: E
authors.lastname: Berglin
authors.forename: G
authors.initials: G
authors.lastname: William-Olsson
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001026:Coronary Artery Bypass; D005260:Female; D005943:Gluconeogenesis; D005947:Glucose / Q000494:pharmacology; D006801:Humans; D007328:Insulin / Q000494:pharmacology*; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D013152:Splanchnic Circulation
chemical_list: D001786:Blood Glucose; D007328:Insulin; D005947:Glucose