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Insulin fails to limit proteolysis in critically-ill medical patients to rates observed after cardiothoracic surgery

Whyte, MB, Jackson, N, Shojaee-Moradie, F, Blauth, C, Beale, R, Treacher, D and Jones, RH (2008) Insulin fails to limit proteolysis in critically-ill medical patients to rates observed after cardiothoracic surgery In: The 7th International Symposium on amino acid/protein metabolism, 2008 - 2008, Padua, Italy.

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Recent data suggest that critically-ill medical patients might not obtain as much benefit from insulin therapy as cardiothoracic patients. This may be because medical patients are more insulin resistant. We have investigated this in both groups. 10 medical patients (age 67.0±4.4 y; 7M:3F, BMI 24.0±1.7 kg/m2; studied within 36 hours of admission to the ICU) and 7 post-operative cardiothoracic patients (age 71.4±3.8 y; 5M:2F, BMI 26.4±1.1 kg/m2; studied within 4 hours of surgery) were recruited. Patients with diabetes mellitus, pancreatitis, liver failure and oral steroid use were excluded. Data are compared to a healthy control group (age 60.0±1.3 y, 4M:1F, BMI 25.0±0.9) undergoing 3-hour euglycaemic clamp. Medical patients received dextrose at 25 kcal/kg/day; postoperative patients at 6.5 kcal/kg/day. In both groups, variable-dose insulin was infused to maintain blood glucose at 7-9 mmol/L. Glucose rate of uptake (Rd) and production (Ra), and leucine Ra (representing proteolysis) were measured with a 3-hour primed infusion of [6,6-2H2] glucose (170 mg, 1.7 mg/min) and [1-13C]leucine (1 mg/kg, 1 mg/kg/hr). Steady state sampling was performed at 150 to 180 minutes. Endogenous glucose Ra was calculated by total glucose Ra minus dextrose infusion rate. Data are mean ± S.E.M. Insulin infusion rate was 3.7±0.8 U/hr (medical), 2.0±0.7 U/hr (surgical patients) and 2.2±0.2 U/hr in controls (NS). Despite the increased provision of dextrose and insulin, medical patients exhibited a higher rate of proteolysis than cardiothoracic patients. If the benefit of exogenous insulin is due to its anabolic action, these findings might explain why insulin therapy is less efficacious in medical than surgical patients.

Item Type: Conference or Workshop Item (Conference Paper)
Subjects : Nutrition
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine > Department of Nutritional Sciences
Authors :
Whyte, MB
Jackson, N
Shojaee-Moradie, F
Blauth, C
Beale, R
Treacher, D
Jones, RH
Date : 2008
Depositing User : Symplectic Elements
Date Deposited : 28 Oct 2016 13:50
Last Modified : 31 Oct 2017 18:52

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