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SUGAR*
IV. EFFECT OF INTRAVENOUS INSULIN AND SIMULTANEOUS
GLUCOSE FEEDING
BY MICHAEL SOMOGYI
(From the Laboratoryof the Jewish Hospital of St. Louis, St. Louis)
(Fteceivedfor publication, March 1, 1949)
This is a report dealing with the effects of insulin upon the rate of
TABLE I
Showing Response of Healthy Men to Insulin Injected Simultaneously with Oral
Administration vj Glucose
Subject 1 Subject 2
5 units insulin intravenously, 100 gm. 3 units insulin intravenously. and SO gm.
glucose by mouth glucose by mouth
that insulin action was so potent that the rate of intestinal absorption of
ghrcose was unable to cope with the rate of assimilation. The resulting
hypoglycemia then activated the insulin-antagonistic mechanism. This
reaction, as we know, is especially responsive to arterial hypoglycemia
(7). As a consequence, the A-V difference increased to only 6.7 mg.
per cent at the half hour period, a response resembling that observed after
the injection of a similar dose of insulin in the postabsorptive state
(6). Small as this increase in the A-V difference is, it still testifies to the
fact that insulin action outstripped the antagonistic factors at the half
hour period, but the balance was only slightly positive in favor of the
insulin. During the second half hour interval, however (i.e., between
30 and 60 minutes after injection), when the arterial blood sugar had
mately 41.6 if the hyperglycemic levels were the same as in the first test.
Comparison of this relative assimilation index with the actual assimilation
index of the first test (which was 47.2), shows a close agreement between
the two. (A similar agreement is, of course, in evidence when one calcu-
lates the assimilation index of the first test for the hyperglycemic levels
of the second test; this figure, 85.2, is fairly close to 75.0, the actual as-
similation index of the second test.)
This is the approach we used for the evaluation of insulin action on the
TABLE II
Method of Calculation of Assimilation Index and Relative Assimilation Index
: 121.6
102.6 14.0
32.9 11.6
16.2 62.7 47.2 (35.2)
0 (89.1) 0 (6.5)
0.5 161.7 72.6 43.2
1 103.3 19.2 21.9
2 92.6 3.6 9.9 96.3 76.0 41.6
tionoccur as a result of insulin injection, and even that increase was insig-
nificant. In one subject (No. 3) there was no change, while in two others
(Nos. 4 and 5) insulin seemingly depressed peripheral assimilation. But
the picture changes if we consider the relative assimilation index, the value
of which is given in the last column of Table III. Comparison of the two
tests on this basis shows in every instance a definite enhancement of the
peripheral glucose assimilation by injected insulin. When this effect was
seemingly absent, it was partly due to the depression of the alimentary
hyperglycemia in the tests with insulin injection, and partly to the handi-
cap under which insulin labored when hypoglycemic states led to the
mobilization of insulin-antagonistic factors.
1Insulin dose
Rise of arterial blood sugar above fastin level,
and A-V differences, at intervals of
- I Hyper-
:lycemi
I lelative
assimi-
0.5 hr. 1 hr. 2 hrs.
sum 22;
Blood A-V Blood A-V Blood A-V
sugar sugar sugar
-- --- --
units
None 74.2 29.1 74.8 31.1 25.9 25.9 174.9 86.1 44.6
5 22.4 52.1 41.0 16.9 27.0 25.7 90.4 94.7
None 73.9 20.2 68.3 9.2 -18.7 4.8 142.2 34.2 17.8
3 5.6 20.5 50.2 8.1 20.2 14.6 76.0 43.2
None 92.6 31.4 105.3 49.2 24.5 29.1 222.4 99.7 84.4
5 97.0 45.1 49.5 26.7 41.7 27.3 188.2 99.1
None 113.1 24.5 79.4 52.1 0.4 8.4 192.9 85.0 28.6
4 33.5 28.6 31.1 27.0 -13.5 13.2 64.4 68.8
None 69.7 23.7 39.0 11.4 45.1 25.9 153.8 61 .O 6.3
5 -19.3 6.7 -3.1 19.7 15.8 13.0 15.8 39.4
- -
SUMMARY
1. Cori, C. F., and Cori, G. T., Proc. Sot. Exp. Biol. and Med., 22, 72 (1924).
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