Comparison of hyperinsulinaemic clamp experiments using venous, 'arterialized' venous or capillary euglycaemia

It has been suggested that deviations from arterial euglycaemia during hyperinsulinaemic clamp experiments that use venous plasma glucose measurements may alter the results of such tests (glucose infusion rate, C-peptide suppression, etc.) and that 'arterialized' venous blood ('heated-hand' technique) may be suitable to circumvent these problems. Therefore, nine normal male fasting volunteers (age 25+/-4 years, body mass index 23.5+/-2.3 kg m(-2)) were examined three times using an insulin infusion of 1 mU kg min(-1) over 120 min. Glucose was infused to maintain a concentration of 4.7 mmol l(-1) (85 mg dl(-1)) in venous (V), 'arterialized' venous ('heated-hand' technique; HH), or capillary (C) plasma. The 'heated-hand' technique caused a rise in (rectal) body temperature of 0.3+/-0.1 degrees C (P<0.0001). Whereas the glucose aim was reached to a similar degree in all experiments (P=0.36), capillary glucose concentrations differed slightly, but significantly (higher in experiments with venous and 'arterialized' venous blood specimens; P=0.034). There were no significant differences regarding steady-state insulin concentrations (P=0.77), glucose infusion rates (V, 7.1+/-0.5; HH, 7.2+/-0.6; C, 6.4+/-0.5 mg kg(-1) min(-1); P=0.98), C-peptide suppression (P=0.78), reduction in glucagon (P=0.27) and free fatty acids (P=0.16), and all parameters of indirect calorimetry (non-protein RQ: P=0.67; glucose and lipid oxidation: P=0.72 and 0.46 respectively; and energy expenditure: P=0.42). Therefore, hyperinsulinaemic clamp experiments performed using venous, 'arterialized' venous, or capillary euglycaemia appear to be almost equally useful for the determination of insulin sensitivity and C-peptide or glucagon suppression. The elevation in body temperature that accompanies use of the 'heated-hand' technique does not noticeably influence measured metabolic parameters.