title: Hyperglycemia and insulin resistance: possible mechanisms.
abstract: Sustained hyperglycemia impairs insulin-stimulated glucose utilization and glycogen synthesis in human and rat skeletal muscles, a phenomenon referred to clinically as glucose toxicity. In rat extensor digitorum longus (EDL) muscle preparations preincubated for 2-4 h in a hyperglycemic medium (25 mM vs. 0 mM glucose), we have shown that the ability of insulin to stimulate glucose incorporation into glycogen is impaired. Interestingly, this was associated with a decreased activation of Akt/PKB, but not its upstream regulator, PI3-kinase. A similar pattern of signaling abnormalities has been observed in adipocytes, L6 muscle cells, C2C12 cells, and (as reported here) EDL incubated with C(2)-ceramide. On the other hand, no increase was observed in ceramide mass in EDL incubated with 25 mM glucose. Hyperglycemia-induced insulin resistance also has been described in adipocytes, where it has been linked to activation of novel and conventional protein kinase C isoforms that phosphorylate the insulin receptor and IRS. In addition, we have recently shown that hyperglycemia causes insulin resistance in cultured human umbilical vein endothelial cells (HUVEC). Here, it was associated with an increased propensity to apoptosis and, as in muscle, with an impaired ability of insulin to activate Akt. Interestingly, these effects of hyperglycemia and an increase in diacylglycerol synthesis, which is also caused, were prevented by adding AICAR, an activator of AMP-activated protein kinase (AMPK), to the incubation medium. These results suggest that hyperglycemia causes insulin resistance in cells other than those in classic insulin target tissues. Whether AMPK activation can reverse or prevent insulin resistance in all of these cells remains to be determined.
authors.affiliation: Diabetes and Metabolism Research Unit, Department of Medicine, and Section of Endocrinology, Boston University School of Medicine, Massachusetts 02118, USA.
authors.forename: Eva
authors.initials: E
authors.lastname: Tomás
authors.forename: Yen-Shou
authors.initials: YS
authors.lastname: Lin
authors.forename: Zeina
authors.initials: Z
authors.lastname: Dagher
authors.forename: Asish
authors.initials: A
authors.lastname: Saha
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Luo
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ido
authors.forename: Neil B
authors.initials: NB
authors.lastname: Ruderman
mesh_terms: D000818:Animals; D003924:Diabetes Mellitus, Type 2; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology*; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance; D018482:Muscle, Skeletal / Q000503:physiopathology; D051381:Rats; D015398:Signal Transduction
chemical_list: D007328:Insulin