Abstract
To examine the glucoregulatory responses to stress and their impact on diabetes, we used the following models of stress: A) Hypoglycemia; B) Epinephrine infusion; C) Intracerebroventricular (ICV) injection of carbachol, an analog of acetylcholine.
-
A)
Hypoglycemia induces release of all counterregulatory hormones. During acute hypoglycemia, glucose production increases initially mainly due to glucagon release but eventually also due to a very large increment in catecholamines. In newborn dogs, neither epinephrine nor glucagon respond to a decrease in plasma glucose. This lack of a safeguard against hypoglycemia may indicate that the brain in pups is less dependent on a normal supply of glucose as a fuel, than in adult dogs. Counterregulation is enhanced when the effects of endogenous opiates are blocked by naloxone, indicating that endogenous opiates play a regulatory role during hypoglycemia. However, beta-endorphins which can be released with epinephrine during various stress situations, potentiate the peripheral effect of epinephrine. Glucoregulatory responses, even to slight changes in plasma glucose, are greatly enhanced during glucocorticoid treatment. This apparently reflects the greater sensitivity of the liver to glucagon. In diabetic dogs, similar to human diabetics, the glucagon response is abolished and the response of the catecholamines is partially decreased. On the basis of histological studies, we proposed that the deficient glucagon response in diabetes could be related to an increase in the somatostatin-glucagon ratio in the diabetic pancreas. This ratio is further augmented when normoglycemia is maintained with insulin. In response to a decrease in plasma glucose, there is a biphasic increment in glucose production in normal dogs, which is missing in diabetes. When normoglycemia is restored in diabetic dogs with phlorizin treatment, the second but not the first increment in glucose production is restored. We postulated, therefore, that the toxic effect of hyperglycemia, in addition to the lack of glucagon response, is the main reason why in diabetes, glucose production cannot respond promptly to a decrease in plasma glucose. The low rate of metabolic clearance of glucose seen in diabetes in the post-absorptive state, also reflects, at least in part, the toxic effect of glucose, because with acute normalization of glucose with phlorizin, metabolic glucose clearance substantially improves. Hyperglycemia is the main reason for the decreased number of glucose transporters in diabetic muscle.
-
B)
Epinephrine infusion in normal dogs mimics some effects of stress, in that it increases glucose production, inhibits metabolic glucose clearance and increases lipolysis. These metabolic effects of epinephrine are independent of glucagon release. In diabetes, however, epinephrine-induced hyperglycemia is exaggerated which is mainly due to glucagon. This occurs both because of excessive glucagon release, and increased hepatic sensitivity to the effects of glucagon related to hypoinsulinemia.
-
C)
ICV injection of a small amount of carbachol induces a release of all counterregulatory hormones. Interestingly, insulin secretion is not affected, possibly because the alpha- and beta-adrenergic pancreatic inputs are balanced. Surprisingly, this release of counterregulatory hormones induces only a marginal change in plasma glucose, since increased glucose production is matched by a similar increase in glucose uptake. In contrast, in hyperglycemic diabetic dogs, the same carbachol injection induces a much larger increment in plasma glucose. This occurred because the metabolic clearance rate of glucose did not increase. We therefore postulated a neural mechanism which controls peripheral glucose uptake and requires a permissive effect of insulin. Somatostatin, injected ICV before carbachol, abolishes most counterregulatory responses as well as the increment in glucose turnover. Lipolysis is also decreased but FFA re-esterification is abolished, reflecting a decrease in glucose uptake in the adipocyte.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
A. D. Cherrington, J. E. Liljenquist, G. I. Shulman, Importance of hypoglycemia-induced glucose production during isolated glucagon deficiency, Am J Physiol, 236:E263–E271 (1979).
N. J. Christensen, K. G. M. M. Alberti, and O. Brandsborg, Plasma catecholamines and blood substrate concentrations: studies in insulin-induced hypoglycemia and after adrenaline infusions, Eur J Clin Invest, 5:415–423 (1975).
Sacca, L., Perez, G., Carteni, G., and F. Rengo, Evaluation of the role of the sympathetic nervous system in the glucoregulatory response to insulin-induced hypoglycemia in the rat. Endocrin, 101:1016–1022 (1977).
R. A. Rizza, P. E. Cryer, and J. E. Gerich, Role of glucagon, catecholamines and growth hormone in human glucose counterregulation. Effects of somatostatin and combined alpha-and beta-adrenergic blockade in plasma glucose recovery and glucose flux rate after insulin-induced hypoglycemia. J Clin Invest, 64:62–70 (1979).
C. Gauthier, M. Vranic, and G. Hetenyi, Jr., Importance of glucagon in regulatory rather than emergency responses to hypoglycemia, Am J Physiol, 238:E131–E140 (1980).
A. J. Garber, I. E. Karl, and D. M. Kipnis, Alanine and glutanine synthesis and release from skeletal muscle. IV. Beta-adrenergic inhibition of amino acid release, J Biol Chem, 251:1851–1857 (1976).
D. W. Biggers, S. R. Myers, D. Neal, R. Stinson, N.B. Cooper, J. B. Jaspen, P. E. Williams, A. D. Cherrington, and R. T. Frizzell, Role of brain in counterregulation of insulin-induced hypoglycemia in dogs, Diabetes, 37:7–16 (1989).
L. Rosetti, D. Smith, G. L. Shulman, D. Papachristou, and R. A. DeFronzo, Correlation of hyperglycemia with phlorizin normalizes tissue sensitivity to insulin in diabetic rats, J Clin Invest 79:1510–1515 (1987).
B. Lussier, M. Vranic, N. Kovacevic, and G. Hetenyi, Jr., Glucoregulation in alloxan diabetic dogs, Metab, 35:18–24 (1986).
G. Hetenyi, Jr., C. Gauthier, M. Byers, and M. Vranic, Phlorizin induced normoglycemia partially restores glucoregulation in diabetic dogs, Am J Physiol, 256:E277–E283 (1989).
A. Klip, T. Ramlal, D. Dimitrakoudis, P. J. Bilan, G. Cartee, E. Gulve, J. O. Holloszy, and M. Vranic, The subcellular distribution of glucose transporters (GTs) in normal and diabetic rat skeletal muscle is regulated by hyperglycemia and insulin, Endocrine Society, p. 47, (Abstract 89). (1990).
K. M. A. El-Tayeb, P. L. Brubaker, H. L. A. Lickley, E. Cook, and M. Vranic, Effect of opiate receptor blockade on normoglycemic and hypoglycemic glucoregulation, Am J Physiol, 250:E236–E242 (1986).
C. Gauthier, and G. Hetenyi, Jr., Origin of glucose released in the regulatory response against hypoglycemia, Metab, 31:147–153 (1982).
C. Gauthier, M. Vranic, and G. Hetenyi, Jr., Nonhypoglycemic glucoregulation: role of glycerol and glucoregulatory hormones, Am J Physiol, 244:E373–E379 (1983).
M. R. Brown, and L. A. Fisher, Central nervous systems effects of corticotropin releasing factor in the dog, Brain Research, 280:75–79 (1983).
D. H. Wasserman, H. L. A. Lickley, and M. Vranic, Interactions between glucagon and other counterregulatory hormones during normoglycemic and hypoglycemic exercise, J Clin Invest, 74:1404–1413 (1984).
G. Hetenyi Jr., S. Varma and J. S. Cowan, Relations between blood glucose and hepatic glucose production in newborn dogs, Brit Med J(2)625–627, #5814 (1972).
G. Hetenyi Jr., N. Kovacevic, S. E. H. Hall, and M. Vranic, Plasma glucagon in pups, decreased by fasting, unaffected by somatostatin or hypoglycemia, Am J Physiol 231:1377–1382 (1976).
J. S. Cowan, and G. Hetenyi Jr., Hypoglycemia in newborn dogs provokes substantial ACTH but probably not adrenaline secretion, Can J Physiol Pharm 57:476–484 (1979).
K. Nakao, Y. Nakai, H. Jingami, S. Oki, J. Fukata, and H. * Imura, Substantial rise of plasma beta-endorphin levels after insulin-induced hypoglycemia in human subjects. J Clin Endocrinol Metab, 49:838–841 (1979).
F. Fraioli, C. Moretti, D. Paolucci, E. Alicicco, F. Crescenzi, and G. Fortunio, Physical exercise stimulates marked concomitant release of beta-endorphin and adrenocorticotropic hormone (ACTH) in peripheral blood in man, Experimientia, 36:987–989 (1980).
M. Feldman, R. S. Kiser, R. H. Unger, and C. H. Li, Beta-endorphin and the endocrine pancreas, studies in healthy and diabetic human beings, N Engl J Med, 300:349–353 (1983).
K. M. A. El-Tayeb, C. J. T. Gauthier, P. L. Brubaker, H. L. A. Lickley, and M. Vranic, Hormonal and metabolic responses to intracarotid and intrajugular infusion of beta-endorphin in normal dogs, Can J Physiol Pharmacol, 64:306–310 (1986).
J. A. Nash, P. M. Radosewich, B. Lacy, N. Rizk, H. Hourani, P. E. Williams and N. Abumrad, Effects of naloxone on glucose homeostasis during insulin-induced hypoglycemia, Am J Physiol, 257:E367–E373 (1989).
S. Caprio, G. Gerety, M. Diamond, W. V. Tamborlane, and R. S. Sherwin, Naloxone enhances the hepatic response to hypoglycemia in diabetics with defective counterregulation, Diabetes, 38(suppl.2):4A, (Abstract) (1989).
K. M. A. El-Tayeb, P. L. Brubaker, M. Vranic, and H. L A. Lickley, Beta-endorphin modulation of the glucoregulatory effects of repeated epinephrine infusion in normal dogs. Diabetes 34:1293–1300 (1985).
D. E. Gray, H. L. A. Lickley, and M. Vranic, Physiologic effects of epinephrine on glucose turnover and plasma free fatty acid concentrations mediated independently of glucagon, Diabetes, 29:600–609 (1980).
K. M. A. El-Tayeb, M. Vranic, P. L. Brubaker, and H. L. A. Lickley, Beta-endorphin modulation of the glucoregulatory effects of epinephrine infusion in alloxan diabetic and normal dogs, Diabetoloqia, 30:745–754 (1987).
R. Ninomiya, N. F. Forbath and G. Hetenyi Jr., Effect of adrenal steroids on glucose kinetics In normal and diabetic dogs, Diabetes 14:729–739 (1965).
J. Campbell, and S.K. Rastogi, Elevation of serum insulin, albumin and FFA with gains of liver lipid and protein induced by glucocorticoid treatment in dogs, Can J Physiol Pharm 46:421–429 (1968).
B. Issekutz Jr. and M. Allen, Effect of catecholamines and methylprednisolone on carbohudrate metabolism of dogs, Metabolism 21:48– 59 (1972).
G. Hetenyi Jr., B. Pagurek, E.A. Dittmar, C. Ferrarotto, The effects of methylprednisolone on the turnover of alanine and on the transfer of carbon atoms from alanine to pyruvate and glucose, Can J Physiol Pharm 58:787– 796 (1980).
B. Lussier, M. Vranic, C. Gauthier, and G. Hetenyi, Jr., Glucoregulation in dogs treated with methylprednisolone, Metabolism 34:906–911 (1985).
P. E. Cryer, and J. G. Gerich, Relevance of glucose counterregulatory system to patients with diabetes, Diabetes Care. 6:95–99 (1983).
G. Bolli, P. De Feo, P. Campagnucci, M. G. Cartechini, G. Angeletti, F. Santeusanio, P. Brunetti, and J. E. Gerich, Abnormal glucose counterregulation in insulin dependant diabetes mellitus: interaction of anti-insulin antibodies and impaired glucagon and epinephrine secretion, Diabetes, 32:134–141 (1983).
P. E. Cryer, Hypoglycemic glucose counterregulation in patients with insulin dependant diabetes mellitus, J Clin Lab Med, 99:451–456 (1982).
H. Drost, D. Gruneklee, K. Kley, W. Wiegelman, H. L. Kruskemper, and F. A. Gries, Untersuchungen zur gluckagon-, STK-, cortisolsekretion bei insulininduzierter hypoglykamie bie insulabhangigen diabetikern ohne neuropathie, Klin Wochenschr, 58:1197–1202 (1980).
J. E. Gerich, M. Langlois, C. Noacco, J. Karam, and P. H. Forsham, Lack of glucagon response to hypoglycemia in diabetes: evidence for an intrinsic pancreatic alpha-cell defect, Science, 182: 171–173 (1973).
O. Bjorkman, P. Miles, D. Wasserman, L. Lickley and M. Vranic, Regulation of glucose turnover during exercise in pancreatectomized totally insulin deficient dogs: Effects of Adrenergic blockade, J. Clin. Invest 81:1759– 1767 (1988).
T. Ramlal, S. Rastogi, M. Vranic, and A. Klip, Decrease in glucose tranporter number in skeletal muscle of mild diabetic (streptozotocin-treated) rats, Endocrinology 125:890–897 (1989).
G. Perez, F. W. Kemmer, H. L. A. Lickley, and M. Vranic, Importance of glucagon in mediating epinephrine-induced hyperglycemia in alloxan-diabetic dogs, Am J Physiol, 241(4):E328–E335 (1981).
F. G. McDaniel, Acute suppression of hepatic gluconeogenesis by glucose in the intact animal Am J Physiol, 229:E569–E575 (1975).
L. Hue, Gluconeogenesis and its regulation, Diabetes/Metabolism Reviews, 3:111–126 (1987).
M. E. Wemette-Haymond, and H. A. Landy, Regulation of gluconeogenesis in hepatocytes in fasted alloxan diabetic rats, Diabetes, 34:767–773 (1985).
K. S. Rastogi, L. Lickley, M. Jokay, S. Efendic, and M. Vranic, Paradoxical reduction in pancreatic glucagon with normalization of somatostatin and decrease in insulin in normoglycemic alloxan diabetic dogs: A putative mechanism of glucagon irresponsiveness to hypoglycemia, Endocrin, 126:1096–1104 (1990).
E. Chen, I. Komiya, L. Inman, K. McCorkle, T. Alam, and R. H. Unger, Metabolic and cellular responses of islet during pertubations of glucose homeostasis determined by in situ hybridization histochemistry, Proc Natl Acad Sci. U.S.A.. 86:1367 (1989).
M. Vranic, H. L. A. Lickley and J. K. Davidson, Exercise and stress in diabetes mellitus. In: Clinical Diabetes Mellitus: A problem oriented approach. (ed J. K. Davidson). Thieme-Stratton Inc., New York, pp. 172– 205 (1986).
D. H. Wasserman, H. L. A. Lickley, and M. Vranic, Important role of glucagon during exercise and diabetes, J Appl Physiol, 59(4):1272–1281 (1985).
D. H. Wasserman, H. L. A. Lickley, and M. Vranic, Role of beta-adrenergic mechanisms during exercise in poorly-controlled insulin deficient diabetes, J Appl Physiol. 59:1282–1289 (1985).
E. Simatirakis, P. D. G. Miles, M. Vranic, R. Hunt, R. Gougen-Rayburn, C. J. Field and E. B. Marliss, Glucoregulation during single and repeated bouts of intense exercise and recovery in man Clin Invest Med 13(4), Abstract 134 (1990).
R. A. Rizza, M. Haymond, P. Cryer, and J. Gerich, Differential effects of epinephrine on glucose production and disposal in man Am J Physiol. 237:E356–E362 (1979).
R. N. Bergman, Integrated control of hepatic glucose metabolism in the dog Ann NY Acad Sci, 148:441–468 (1977).
B. Issekutz, Role of beta-adrenergic receptors in mobilization of energy sources in exercising dogs J Appl Physiol, 44:869–876 (1978).
G. I. Shulman, J. E. Liljenquist, P. E. Williams, W. W. Lacy, and A. D. Cherrington, Glucose disposal during insulinopenia in somatostatin-treated dogs J Clin Invest, 62:478–491 (1978).
L. Kepinov, and S. Petit-Dutaillis, Action hyperglycemiate du sang du chien diabetique, Arch Int Physiol, 34:48–100 (1931).
R. H. Linger, Role of glucagon in the pathogenesis of diabetes: The status of the controversy, Metab, 27:1691–1709 (1978).
R. H. Linger, and L. Orci, Hypothesis: The essential role of glucagon in the pathogenesis of diabetes mellitus, Lancet, 1:14–16 (1975).
N. Altszuler, B. Gottlieb, and J. Hamshire, Interaction of somatostatin, glucagon and insulin on hepatic glucose output in the normal dog, Diabetes, 25:116–121 (1976).
A. D. Cherrington, J. L. Chiasson, A. S. Jennings, U. Keller, and W. Lacy, The role of glucagon and insulin in the regulation of basal glucose production in the postabsorptive dog, J Clin Invest, 58:1407–1418 (1976).
A. D. Cherrington, W. W. Lacy, and J. L. Chiasson, The effects of glucagon on glucose production during insulin deficiency in the conscious dog, J Clin Invest, 62:664–677 (1978).
H. L. A. Lickley, G. G. Ross, and M. Vranic, Effects of selective insulin or glucagon deficiency on glucose turnover, Am J Physiol, 236:E255–E262 (1979).
J. E. Gerich, M. Lorenzi, E. Tsalikian, and J. H. Karam, Studies on the mechanism of epinephrine-induced hyperglycemia in man, Diabetes, 25:67–71 (1976).
H. Shamoon, R. Hendler, and R. Sherwin, Altered responsiveness to Cortisol, epinephrine and glucagon in insulin-infused juvenile onset diabetics: a mechanism for diabetic instability, Diabetes, 29:284–291 (1980).
F. W. Kemmer, A. Sirek, O. V. Sirek, G. Perez, and M. Vranic, Glucoregulatory mechanisms following hypophysectomy in diabetic dogs with residual insulin secretion, Diabetes, 23:26–34 (1983).
F. W. Kemmer, H. L. A. Lickley, D. E. Gray, G. Perez, and M. Vranic, The state of metabolic control determines the role of epinephrine-glucagon interactions of glucoregulation in diabetes, Am J Physiol, 242(4):E428–E436 (1982).
K. Doi, M. Prentiki, C. Yip, W. Muller, B. Jeanrenaud, and M. Vranic, Identical biological effects of pancreatic glucagon and a purified moiety of canine gastric glucagon, J Clin Invest, 63:525–531 (1979).
T. W. Hatton, C. C. Yip, and M. Vranic, Biosynthesis of glucagon (IRG3500) in canine gastric mucosa, Diabetes. 34:38–46 (1985).
R. R. Wolfe, M. J. Durkot, J. R. Allsop, and J. F. Burke, Glucose metabolism in severly burned patients, Metab, 28:1031–1039 (1979).
G. L Clifton, M. G. Ziegler, and R. G. Grossman, Circulating catacholamines and sympathetic activity after head injury Neurosurgery8:10–14 (1981).
J. B. Halter, A. E. Pflug, and D. Porte, Jr., Mechanism of plasma catecholamine increases during surgical stress in man J Clin Endocrinol Metab, 45:936–944 (1977).
P. E. Cryer, Physiology and pathophysiology of the human sympathoadrenal neuroendocrine system, N Engl J Med. 303:436–444 (1980).
N. J. Christensen, and J. Videbaek, Plasma catecholamines and carbohydrate metabolism in patients with acute myocardial infarction, J Clin Invest. 54:278–286 (1974).
F. W. Kemmer, R. Bisping, H. J. Steingruber, H. Baar, F. Hartman, R. Schlagheche, and M. Berger, Psychological stress and metabolic control in patients with type I diabetes mellitus, N Engl J Med. 314:1078–1084 (1986).
M. Vranic, R. Kawamori, S. Pek, N. Kovacevic and G. A. Wrenshall, The essentiality of insulin and the role of glucagon in regulating glucose utilization and production during strenuous exercise in dogs, J Clin Invest. 57:245–256 (1976).
M. Vranic, and G. A. Wrenshall, Exercise, insulin and glucose turnover in dogs, Endocrin. 85:165–171 (1969).
M. R. Brown, J. Rivier, and W. Vale, Somatostatin: Central nervous systems action on glucoregulation, Endocrin. 140:1709–1715 (1979).
P. S. Sebel, in: Hazards and complications of anaesthesia, T. H. Taylor and E. Major, eds. New York, NY, Churchill Livingston (1987).
P. Miles, K. Yamatani, L. Lickley, and M. Vranic, Mechanism of glucoregulatory responses to stress and their deficiency in diabetes. Proc. Natl. Acad. Sci. U.S.A.. (1990) (in press).
M. R. Brown, and L. A. Fisher, Brain peptide regulation of adrenal epinephrine secretion, Am J Physiol. 247:E41–E46 (1984).
M. R. Brown, Neuropeptides: Central nervous systems effects on nutrient metabolism, Diabetologia. 20:299–304 (1981).
P. D. G. Miles, K. Yamatani, H. L. A. Lickley, and M. Vranic, The intracerebroventricular injection of a somatostatin analog (ODT8-SS) suppresses the stress response in normal and diabetic dogs, Program of International Symposium on Somatostatin, Montreal, Canada. Abstract 68, (1989).
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1991 Plenum Press, New York
About this chapter
Cite this chapter
Vranic, M. et al. (1991). Effect of Stress on Glucoregulation in Physiology and Diabetes. In: Vranic, M., Efendic, S., Hollenberg, C.H. (eds) Fuel Homeostasis and the Nervous System. Advances in Experimental Medicine and Biology, vol 291. Springer, Boston, MA. https://doi.org/10.1007/978-1-4684-5931-9_13
Download citation
DOI: https://doi.org/10.1007/978-1-4684-5931-9_13
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4684-5933-3
Online ISBN: 978-1-4684-5931-9
eBook Packages: Springer Book Archive