Diabetogia: Insulin sensitivity depends on the way glucose is administered.

!---- bariatric surgery showed that the small intestine plays an important role in the liver and body insulin sensitivity.our goal is to study whether glucose-to-drug pathways and doses have an acute effect on insulin sensitivity.the main endpoint of this proof-of-concept study is the difference in insulin-mediated glucose metabolism removal rate (MCR/I) between oral and intravenous pathways.secondary endpoint is the effect of insulin on protein hydrolysis, ketone production, lipolythedandasis and glucagon levels.in this parallel cohort study, we performed multiple oral glucose loads on 23 participants with morbid obesity, normal glucose tolerance or impaired or type 2 diabetes (between the ages of 18 and 65).at another stage, we give intravenous infusions of sugar glucose (IGIVI) to match the blood sugar levels observed during oral challenges.the appearance (Ra), vanishing (Rd) and endogenous glucose generation (EGP) by injecting them with glucose of 6, 6-2h2 and oral glucose (U-13C6) glucose.use gas chromatography and flight time mass spectrometry to determine plasma small polar metabolites.use ultra-efficient liquid chromatography and quadromatography to determine lipids.measureg glucagon-like peptide-1, insulin, c peptide and glucagon.participants, caregivers, people who take measurements or checks, and those who perform the results are not affected by group assignments.glucose MCR/I during IGIVI is higher than during oral glucose administration, but is independent of blood glucose status (IGIVI is 12 x 6 ml, oral per nmol / l is 7.4 x 3 ml min-1 kg-1, paired t-test p .lt;0.001).insulin secretion during oral administration was higher than during IGIVI (p.lt;0.001).significantly reduced disposal index during oral process: 4260 to 1820 to 5000 x 2360 (ml min-1 kg-1 (nmol / l)-1 pmol / min; p . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .infusion rather than oral glucose, the rate of insulin removal was significantly higher (intravenous and oral methods were 2.53 x 0.82 vs 2.16 x 0.49 l / min, p-0.006, respectively). Afteroral glucose load, insulin inhibits lipolytherapy and protein hydrolysis.heat map shows different metabolite patterns between the two glucose-toe pathways.studies have shown that insulin sensitivity depends on the glucose-toe route, which leads to increased insulin secretion and compensating insulin resistance compared to intravenous administration.insulin blocked fat breakdown and protein breakdown after oral glucose load was less effective than intravenous pathways.our results show that although glucose-mediated insulin release is accompanied by an increase in insulin release, the effect of insulin release is limited by increased insulin resistance..