Acute exercise, epinephrine, and diabetes enhance insulin binding to skeletal muscle

Regional Variation in Skeletal Muscle and Adipose Tissue FDG Uptake Using PET/CT and Their Relation to BMI

RATIONALE AND OBJECTIVES

Skeletal muscle metabolism is a primary contributor to whole-body energy expenditure. Currently, methods to measure changes in skeletal muscle metabolism in vivo are limited. Our objectives were to characterize the regional variation in skeletal muscle and adipose tissue (AT) FDG uptake as a surrogate for glycolytic metabolism using ¹⁸F-2-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in healthy men and to correlate these findings to body mass index (BMI).

MATERIALS AND METHODS

Eighteen healthy men were enrolled and underwent FDG-PET/CT. The mean standardized uptake value of 14 skeletal muscles and two AT regions was measured and linear regression analysis was performed to identify metabolic predictors of BMI.

RESULTS

FDG-PET/CT reliably detected changes in skeletal muscle and AT depot metabolic activity based on location. The most metabolically active muscles were those used for posture and breathing, which have the highest percentage of reported type I muscle myofiber content. Visceral AT tended to have a higher FDG uptake than subcutaneous AT. The mean standardized uptake value of VAT, pectoralis major, and gluteus maximus muscles accounted for 64% of the variance in BMI.

CONCLUSIONS

FDG-PET/CT can be used to quantify the regional variation in glucose metabolism of multiple skeletal muscle groups and AT depots.

Physiological bases for the treatment of the physically active individual with diabetes

Substrate utilisation and glucose homoeostasis during exercise is controlled by the effects of precise changes in insulin, glucagon and the catecholamines. The important role these hormones play is clearly seen in people with diabetes, as the normal endocrine response is often lost. In individuals with insulin-dependent diabetes (IDDM), there can be an increased risk of hypoglycaemia during or after exercise or, conversely, there can be a worsening of the diabetic state if insulin deficiency is present. In contrast, it appears that people with non-insulin-dependent diabetes (NIDDM) can generally exercise without fear of a deleterious metabolic response. The exercise response both in healthy subjects and in those with diabetes is dependent on many factors such as age, nutritional status and the duration and intensity of exercise. Since there are so many variables which govern individual response to exercise, an exact exercise prescription for all people with diabetes cannot be made. There are many adjustments to the therapeutic regimen which an individual with IDDM can make in order to avoid hypoglycaemia during or after exercise. In general, a reduction in insulin dosage and the added ingestion and continual availability of carbohydrates are wise precautions. On the other hand, exercise should be postponed if blood glucose is greater than 2500 mg/L and ketones are present in the urine. As more is understood about the regulation of substrate metabolism during exercise, more refined therapeutic strategies can be defined. An understanding of the metabolic response to exercise is critical for generating an effective and safe training programme for all diabetic individuals who wish to be physically active.

Response of muscle protein turnover to insulin after acute exercise and training

To determine whether the enhanced insulin-sensitivity of glucose metabolism in muscle after acute exercise also extends to protein metabolism, untrained and exercise-trained rats were subjected to an acute bout of exercise, and the responses of protein synthesis and degradation to insulin were measured in epitrochlearis muscles in vitro. Acute exercise of both untrained and trained rats decreased protein synthesis in muscle in the absence or presence of insulin, but protein degradation was not altered. Exercise training alone had no effect on protein synthesis or degradation in muscle in the absence or presence of insulin. Acute exercise or training alone enhanced the sensitivities of both protein synthesis and degradation to insulin, but the enhanced insulin-sensitivities from training alone were not additive to those after acute exercise. These results indicate that: a decrease in protein synthesis is the primary change in muscle protein turnover after acute exercise and is not altered by prior exercise training, and the enhanced insulin-sensitivities of metabolism of both glucose and protein after either acute exercise or training suggest post-binding receptor events.