title: Plasma C5 glucose-to-2H2O ratio does not provide an accurate assessment of gluconeogenesis during hyperinsulinemic-euglycemic clamps in either nondiabetic or diabetic humans.
abstract: OBJECTIVE
  Measurement of plasma C2 glucose enrichment is cumbersome. Therefore, the plasma C5 glucose-to-(2)H(2)O rather than the plasma C5-to-C2 glucose ratio commonly has been used to measure gluconeogenesis and glycogenolysis during hyperinsulinemic-euglycemic clamps. The validity of this approach is unknown.
  
  
  METHODS
  Ten nondiabetic and 10 diabetic subjects ingested (2)H(2)O the evening before study. The following morning, insulin was infused at a rate of 0.6 mU . kg(-1) . min(-1) and glucose was clamped at approximately 5.3 mmol/l for 5 h. Plasma C5 glucose, C2 glucose, and (2)H(2)O enrichments were measured hourly from 2 h onward.
  
  
  RESULTS
  Plasma C2 glucose and plasma (2)H(2)O enrichment were equal in both groups before the clamp, resulting in equivalent estimates of gluconeogenesis and glycogenolysis. In contrast, plasma C2 glucose and plasma C5 glucose enrichments fell throughout the clamp, whereas plasma (2)H(2)O enrichment remained unchanged. Since the C5 glucose concentration and, hence, the C5 glucose-to-(2)H(2)O ratio is influenced by both gluconeogenesis and glucose clearance, whereas the C5-to-C2 glucose ratio is only influenced by gluconeogenesis, the C5 glucose-to-(2)H(2)O ratio overestimated (P < 0.01) gluconeogenesis during the clamp. This resulted in biologically implausible negative (i.e., calculated rates of gluconeogenesis exceeding total endogenous glucose production) rates of glycogenolysis in both the nondiabetic and diabetic subjects.
  
  
  CONCLUSIONS
  Plasma C5 glucose-to-(2)H(2)O ratio does not provide an accurate assessment of gluconeogenesis in nondiabetic or diabetic subjects during a traditional (i.e., 2-3 h) hyperinsulinemic-euglycemic clamp. The conclusions of studies that have used this approach need to be reevaluated.
authors.affiliation: Division of Endocrinology, Diabetes, Metabolism, and Nutrition,Mayo Clinic College of Medicine, Rochester, Minnesota. USA. rizza.robert@mayo.edu
authors.forename: Rita
authors.initials: R
authors.lastname: Basu
authors.forename: Visvanathan
authors.initials: V
authors.lastname: Chandramouli
authors.forename: Betty
authors.initials: B
authors.lastname: Dicke
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Landau
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rizza
mesh_terms: D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D017666:Deuterium Oxide / Q000097:blood*; D003920:Diabetes Mellitus / Q000097:blood*; D005934:Glucagon / Q000031:analogs & derivatives / Q000494:pharmacology; D005943:Gluconeogenesis; D015309:Glucose Clamp Technique / Q000379:methods*; D006003:Glycogen / Q000378:metabolism; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000494:pharmacology*; D007700:Kinetics; D012016:Reference Values; D015203:Reproducibility of Results; D013004:Somatostatin / Q000008:administration & dosage / Q000494:pharmacology; D014867:Water
chemical_list: D001786:Blood Glucose; D007328:Insulin; D014867:Water; D019382:Human Growth Hormone; D013004:Somatostatin; D006003:Glycogen; D005934:Glucagon; D017666:Deuterium Oxide