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, were sequentially performed an intravenous glucose (plus [2- 3H]glucose) tolerance test (IVGTT) and a euglycemic insulin clamp during either a saline infusion or a low (1.6 μmol · min-1 · kg-1) or high (5 μmol · min-1 · kg-1 [n = 5]) GlcN infusion. β-Cell secretion, insulin (S(I)*-IVGTT), and glucose (S(G)*) action on glucose utilization during the IVGTT were 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 (Δ ~.5-0.8 mmol/l, P < 0.03-0.01) and plasma fasting glucose levels (Δ ~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 were measured by indirect calorimetry) during the clamp. However, high levels of GlcN caused a decrease in S1*-IVGTT (Δ ~30%, P < 0.02) and in S(G)* (Δ ~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.