Physiologische und pathophysiologische Grundlagen der Kohlenhydrathomöostase

P. R. Bratusch-Marrain

doi:10.1055/s-0038-1656621

Hämostaseologie, Table of Contents

Hamostaseologie 1983; 03(03): 77-84
DOI: 10.1055/s-0038-1656621

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Schattauer GmbH

Physiologische und pathophysiologische Grundlagen der Kohlenhydrathomöostase

P. R. Bratusch-Marrain

¹Aus der I. Medizinischen Universitätsklinik Wien (Vorstand: Prof. Dr. Dr. h. c. E. Deutsch), Abteilung für Klinische Endokrinologie und Diabetes mellitus (Leiter: Prof. Dr. W. Waldhäusl)

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Abstract

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Zusammenfassung

Die Kontrolle der Blutglukosekonzentration erfolgt durch eine Vielzahl von Regulationsmechanismen, deren Effizienz sich beim gesunden Organismus in einer nur sehr schmalen Bandbreite der Schwankungen der Blutglukosekonzentration manifestiert. Neben Insulin sind nicht nur eine Vielzahl anderer Hormone, wie Glukagon, Katecholamine, Glukokortikoide und Wachstumshormon, sondern auch zentralnervöse Steuerungsmechanismen an der Aufrechterhaltung der Glukosehomöostase beteiligt. Aufgabe dieser Kontrollsysteme ist es, trotz intermittierender Nahrungszufuhr und zeitlich davon unabhängigem, aber ebenfalls intermittierendem Energiebedarf, Hypo- und Hyperglykämien zu verhindern. Die Kenntnis dieser integrativen Steuerung des Metabolismus der Einzelorgane im Rahmen des Gesamtorganismus stellt die Voraussetzung für diagnostische und therapeutische Überlegungen bei mit Störungen der Stoffwechselhomöostase einhergehenden pathologischen Zuständen dar.

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References

LITERATUR
1 Martin C. R. Textbook of Endocrine Physiology.. Williams & Wilkins Company; Baltimore: 1976
2 Porte Jr. D, Halter J. B, de Hean Ch, Palmer J. P, Asplin Ch. M, Graf R. J, Pfeifer M. A. Diabetes mellitus: selected aspects of pathophysiology and clinical practice.. In Freinkel N. (ed.) Contemporary Metabolism vol 1982; 2: 1-59.
3 Steiner D. F, Freinkel N. Endocrine Pancreas. Section 7, vol. 1 of Handbook of Physiology, Amer. Physiol. Soc.. Washington, D. C: 1972
4 Fajans S. S, Floyd J. C, Knopf R. F. Effect of amino acids and proteins on insulin secretion in man.. Recent. Progr. Horm. Res 1967; 23: 617-656.
5 Halter J. B, Porte Jr. D. Current concepts of insulin secretion in diabetes mellitus.. In Rifkin H, Raskin P. (eds.) Diabetes Mellitus, vol.V Robert J. Brady; Bowie Maryland: 1980: 33-42.
6 Nakazo W. Innervation of pancreatic islets.. In: Yagi K, Yoshida S. (eds.) Neuroendocrine Control. J Wiley & Sons; New York: 1973
7 Land D. A, Matthews D. R, Peto J, Turner R. C. Cyclic oscillations of basal plasma glucose and insulin concentrations in human beings.. New. Engl. J. Med 1979; 301: 1023-1027.
8 Waldhäusl W, Gasić S, Bratusch-Marrain P, Korn A, Nowotny P. Feedback inhibition by biosynthetic human insulin of insulin release in healthy human subjects.. Am. J. Physiol 1982; 243: E 476-E 482.
9 Waldhäusl W, Bratusch-Marrain P, Gasić S, Korn A, Nowotny P. Insulin production rate following glucose ingestion estimated by splanchnic C-peptide output in normal man.. Diabetologia 1979; 17: 221-227.
10 Robertson R. P, Guest R. J. Reversal by methysergide of inhibition of insulin secretion by prostaglandin E in the dog.. J. Clin. Invest 1978; 62: 1014-1019.
11 Pilch P. F, Czech M. P. The subunit structure of the high affinity insulin receptor. Evidence for a disulfide-linked receptor complex in fat cell and liver plasma membranes.. J. Biol. Chem 1980; 255: 1722-1731.
12 Roth J, Kahn R, Lesniak M. A, Gorden P, DeMeyts P, Megesyi K, Neville Jr. D. M, Gavin J. R, Soll A. H, Freychet P, Goldfine I. D, Bar R. S, Archer J. A. Receptors for insulin, NSILA-s, and growth hormone: application to disease states in man.. Recent Progr. Horm. Res 1975; 31: 95-126.
13 Carpentier J. L, Gordon P, Barazzone P, Freychet P, LeCam A, Orci L. Intracellular localization of ¹²⁵I-labeled insulin in hepatocytes from intact liver.. Proc. Natl. Acad. Sci. USA, 1979; 26: 2803-2807.
14 Jefferson L. S, Exton J. H, Butcher R. W, Sutherland W, Park C. R. Role of adenosine 3’5’-monophosphate in the effect of insulin and anti-insulin serum on liver metabolism.. J. Biol. Chem 1968; 243: 1031-1038.
15 Cushman S. W, Wardzala L. J. Potential mechanism of insulin action on glucose transport in the isolated rat adipose cell.. J. Biol. Chem 1980; 255: 4758-4762.
16 Bratusch-Marrain P, Waldhäusl W, Gasic S, Korn A, Nowotny P. Oral glucose tolerance test: effect of different glucose loads on splanchnic carbohydrate and substrate metabolism in healthy man.. Metabolism 1980; 29: 289-295.
17 Karpatkin S, Charmatz A, Langer R. M. Glycogenesis and glyconeogenesis in human platelets: incorporation of glucose, pyruvate, and citrate into platelet glycogen; glycogen synthetase and fructose-1,6-diphosphatase activity.. J. Clin. Invest 1970; 49: 140-149.
18 Karpatkin S. Studies on human platelet glycolysis. Effect of glucose, cyanide, insulin, citrate, and agglutination and contraction on platelet glycolysis.. J. Clin. Invest 1967; 46: 409-417.
19 Bern M. M. Platelet functions in diabetes mellitus.. Diabetes 1978; 27: 342-350.
20 Hassanein A. A, El-Garf T. A, El-Baz Z. Platelet aggregation in diabetes mellitus and the effect of insulin in vivo on aggregation.. Thromb. Diath. Haemorrh 1972; 27: 114-120.
21 Axelrod L, Levine L. Plasma prostaglandin levels in rats with diabetes mellitus and diabetic ketoacidosis.. Diabetes 1982; 31: 994-1001.
22 Jeremi J. Y, Mikhailidis D. P, Dandona P. Simulating the diabetic environment modifies in vitro prostacyclin synthesis.. Diabetes 1983; 32: 217-221.
23 Micossi P, Pontiroli A. E, Baron S. H, Tamayo R. C, Lengel F, Bevilacqua M, Raggi U, Norbiato G, Foà P. P. Aspirin stimulates insulin and glucagon secretion and increases glucose tolerance in normal and diabetic subjects.. Diabetologia 1978; 27: 1196-1204.
24 Bratusch-Marrain P, Waldhäusl W, Grubeck-Loebenstein B, Korn A, Vierhapper H, Nowotny P. The role of »diabetogenic« hormones on carbohydrate and lipid metabolism following oral glucose loading in insulin dependent diabetics: Effects of acute hormone administration.. Diabetologia 1981; 21: 387-393.
25 Bratusch-Marrain P. Insulin-counteracting hormones: their impact on glucose metabolism.. Diabetologia 1983; 24: 74-79.
26 Waldhäusl W, Kleinberger G, Korn A, Dudczak R, Bratusch-Marrain P, Nowotny P. Severe hyperglycemia: effects of rehydration on endocrine derangements and blood glucose concentration.. Diabetes 1979; 28: 577-584.
27 Gerich J, Lorenzi M, Bier D, Tsalikian E, Schneider V, Karam J, Forsham P. Effects of physiologic levels of glucagon and growth hormone on human carbohydrate and lipid metabolism.. J. Clin. Invest 1976; 57: 875-884.
28 Unger R. H, Lefebvre P. J. Glucagon physiology. In: Glucagon, Molecular Physiology, Clinical and Therapeutic Implications.. Lefebvre P. J, Unger R. H. (eds.) Pergamon Press, Ltd. Oxford 1972; 15: 213-244.
29 Deibert D. G, DeFronzo R. A. Epinephrine-induced insulin resistance in man.. J. Clin. Invest 1980; 65: 717-721.
30 Rizza R. A, Mandarino L. J, Gerich J. E. Cortisol-induced insulin resistance in man: Impaired suppression of glucose production and stimulation of glucose utilization due to a post-receptor defect of insulin action.. J. Clin. Endocrinol. Metab 1982; 54: 131-138.
31 Bratusch-Marrain P, Smith D, DeFronzo R. A. The effect of growth hormone on glucose metabolism and insulin secretion in man.. J. Clin. Endocrinol. Metab 1982; 55: 973-982.
32 Felig P, Wahren J, Hendler R. Influence of oral glucose ingestion on splanchnic glucose and gluconeogenic substrate metabolism in man.. Diabetes 1975; 24: 468-475.
33 Bratusch-Marrain P, Björkman O, Hagenfeldt L, Waldhäusl W, Wahren J. Influence of arginine on splanchnic glucose metabolism in man.. Diabetes 1979; 28: 126-131.
34 Katz L, Glickman M. G, Rapoport St, Ferrannini E, DeFronzo R. A. Splanchnic and peripheral disposal of oral glucose in man. Diabetes (in press).. 1983
35 Waldhäusl W, Gasić S, Bratusch-Marrain P, Nowotny P. The 75 g oral glucose tolerance test: effects on splanchnic metabolism of substrates and pancreatic hormone release in healthy man. Diabetologia (im Druck).. 1983
36 DeFronzo R. A, Ferrannini E, Hendler R, Wahren J, Felig P. Influence of hyper-insulinemia, hyperglycemia, and the route of glucose administration on splanchnic glucose exchange.. Proc. Natl. Acad. Sci. U.S.A 1978; 75: 5173-5177.
37 Wahren J, Felig P, Hagenfeldt L. Effect of protein ingestion on splanchnic and leg metabolism in normal man and in patients with diabetes mellitus.. J. Clin. Invest 1976; 57: 987-998.
38 Felig P, Sherwin R. S, Soman V, Wahren J, Hendler R, Sacca L, Eigler N, Soldberg D, Walesky M. Hormonal interactions in the regulation of blood glucose.. Rec. Progr. Horm. Res 1979; 35: 501-529.
39 Ahlborg G, Felig P, Hagenfeldt L, Hendler R, Wahren J. Substrate turnover during prolonged exercise in man.. J. Clin. Invest 1974; 53: 1080-1090.
40 Vranic M, Kawamori R, Pek S, Kovacevic N, Wrenshall G. A. The essentiality of insulin and the role of glucagon in regulating glucose utilization and production during strenuous exercise in dogs.. J. Clin. Invest 1976; 57: 245-255.
41 Issekutz B, Vranic M. Significance of glucagon in the control of glucose production during exercise in dogs.. Diabetes 1978; 27 Suppl (Suppl. 02) 454
42 Zinman B, Murray F. T, Vranic M, Albisser A. M, Leibel B. S, McClean P. A, Marliss E. B. Glucoregulation during moderate exercise in insulin treated diabetics.. J. Clin. Endocrinol. Metabol 1977; 45: 641-652.
43 Benson Jr. J. W, Johnson D. G, Palmer J. P, Werner P. L, Ensinck J. W. Glucagon and catecholamine secretion during hypoglycemia in normal and diabetic man.. J. Clin. Endocrinol. Metab 1977; 44: 459-464.
44 DeFronzo R. A, Hendler R, Christensen N. Stimulation of counterregulatory hormone responses in diabetic man by a fall in glucose concentration.. Diabetes 1980; 29: 125-131.
45 Cahill Jr. G. F, Soeldner J. S. A non-editorial on non-hypoglycemia.. N. Engl. J. Med 1974; 297: 905-906.
46 Somogyi M. Diabetogenic effect of hyper-insulinism.. Am. J. Med 1959; 26: 192-198.
47 Feldman J. M, Plonk J. W, Bivens C. H. The role of Cortisol and growth hormone in the counter-regulation of insulin-induced hypoglycemia.. Horm. Metab. Res 1975; 7: 378-381.
48 Garber A. J, Cryer P. E, Santiago J. V, Haymond M. W, Pagliara A. S, Kipnis D. M. The role of adrenergic mechanisms in the substrate and hormonal response to insulin-induced hypoglycemia in man.. J. Clin. Invest 1976; 58: 7-15.
49 Rizza R. A, Cryer P. E, Gerich J. E. Role of glucagon, catecholamines, and growth hormone in human glucose counter-regulation. Effects of somatostatin and combined – and B-adrenergic blockade on plasma glucose recovery and glucose flux rates after insulin-induced hypoglycemia.. J. Clin. Invest 1979; 64: 62-71.
50 Boden G, Reichard G. A, Hoeldtke R. D, Rezvani I, Owen O. E. Severe insulininduced hypoglycemia associated with deficiencies in the release of counterregulatory hormones.. New Engl. J. Med 1981; 305: 1200-1205.
51 Sacca L, Sherwin R, Hendler R, Felig P. Influence of continuous physiologic hyper-insulinemia on glucose kinetics and counterregulatory hormones in normal and diabetic humans.. J. Clin. Invest 1979; 63: 849-857.
52 Viberti G. C, Keen H, Bloom S. R. Beta blockade and diabetes mellitus.. Metabolism 1980; 29: 866-872.
53 Gerich J. E, Langlois M, Noacco C, Karam J. H, Forsham P. H. Lack of glucagon response to hypoglycemia in diabetes: Evidence for an intrinsic pancreatic alpha cell defect.. Science 1973; 182: 171-173.