title: Effect of local sympathetic blockade on forearm blood flow and glucose uptake during hypoglycemia.
abstract: During hypoglycemia, hepatic glucose production increases and peripheral glucose utilization decreases. Systemic beta-adrenergic blockade during hypoglycemia increases peripheral glucose utilization. To explore the local effects of increased alpha- and beta-adrenergic activity on skeletal muscle glucose utilization, we measured arterial and venous plasma glucose concentrations, forearm blood flow (FBF), and forearm glucose uptake (FGU) during a hyperinsulinemic (40 mU/m2/min) stepped-hypoglycemic clamp with intrabrachial artery infusion of saline, phentolamine, propranolol, or combined phentolamine and propranolol. A control study was also performed with a euglycemic clamp and intraarterial saline. During hypoglycemia with saline and phentolamine, there were significant increases in FBF (130% +/- 38% and 180% +/- 35%, respectively) and FGU (120% +/- 51% and 230% +/- 150%, respectively). During hypoglycemia with propranolol and phentolamine + propranolol, FBF remained constant. FGU during hypoglycemia with propranolol was not different versus hypoglycemia with saline. No differences were found in these studies for forearm lactate output (FLO) or venous free fatty acid concentrations. These results demonstrate that local, as opposed to systemic, blockade during hypoglycemia does not alter peripheral glucose utilization.
authors.affiliation: Department of Pediatrics and the Clinical Research Center, University of Iowa College of Medicine, Iowa City, USA.
authors.forename: R P
authors.initials: RP
authors.lastname: Hoffman
authors.forename: C A
authors.initials: CA
authors.lastname: Sinkey
authors.forename: E
authors.initials: E
authors.lastname: Tsalikian
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000494:pharmacology; D000319:Adrenergic beta-Antagonists / Q000494:pharmacology; D000328:Adult; D001340:Autonomic Nerve Block; D001786:Blood Glucose / Q000032:analysis; D004338:Drug Combinations; D004837:Epinephrine / Q000097:blood; D005260:Female; D005542:Forearm / Q000098:blood supply*; D005947:Glucose / Q000378:metabolism*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007003:Hypoglycemia / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D018482:Muscle, Skeletal / Q000378:metabolism*; D009638:Norepinephrine / Q000097:blood; D010646:Phentolamine / Q000494:pharmacology; D011433:Propranolol / Q000494:pharmacology; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology
chemical_list: D000317:Adrenergic alpha-Antagonists; D000319:Adrenergic beta-Antagonists; D001786:Blood Glucose; D004338:Drug Combinations; D011433:Propranolol; D005947:Glucose; D009638:Norepinephrine; D004837:Epinephrine; D010646:Phentolamine