Effects of glucosamine infusion on insulin secretion and insulin action in humans

Glucose toxicity (i.e., glucose-induced reduction in insulin secretion and action) may be mediated by an increased flux through the hexosamine-phosphate pathway: Glucosamine (GlcN) is widely used to accelerate the hexosamine pathway flux, independently of glucose. We tested the hypothesis that GlcN can affect insulin secretion and/or action in humans. In 10 healthy subjects, we sequentially performed an intravenous glucose (plus [2-H-3]glucose) tolerance test (IVGTT) and a euglycemic insulin clamp during either a saline infusion or a low (1.6 mu mol . min(-1) . kg(-1)) or high (5 mu mol . min(-1) . kg(-1) [n = 5]) GlcN infusion. beta-Cell secretion, insulin (S-I*-IVGTT), and glucose (S-G*) action on glucose utilization during the IVGTT R-ere measured according to minimal models of insulin secretion and action. Infusion of GlcN did not affect readily releasable insulin levels, glucose-stimulated insulin secretion (GSIS), or the time constant of secretion, but it increased both the glucose threshold of GSIS (Delta similar to 0.5-0.8 mmol/l, P < 0.03-0.01) and plasma fasting glucose levels (Delta similar to 0.3-0.5 mmol/l, P < 0.05-0.02). GlcN did not change glucose utilization or intracellular metabolism (glucose oxidation and glucose storage n ere measured by indirect calorimetry) during the clamp. However, high levels of GlcN caused a decrease in S-I*-IVGTT (Delta similar to 30%, P < 0.02) and in S-G* (Delta similar to 40%, P < 0.05). Thus, in humans, acute GlcN infusion recapitulates some metabolic features of human diabetes. It remains to be determined whether acceleration of the hexosamine pathway can cause insulin resistance at euglycemia in humans.