Hepatic sensitivity to the insulin in residents from high-altitude and sea level areas using the CLAMPEH method
Abstract
Objectives: To determine and to compare the hepatic sensitivity to the insulin in permanent residents from sea level (Lima, 150 m.s.l, Patm [Atmospheric pressure] = 760 mm Hg) and from high-altitude (Huancayo, 3250 m.s.l, Patm = 520 mm Hg). Methods: It was used the CLAMPEH method. It’s considered the one with more accurately to determine the sensitivity to the insulin, which involves the infusion via venous, and to install two antebrachial catheters with an insulin fixed amount and a variable amount with a volumetric infusion pump. The hepatic sensitivity to the insulin was represented by the value (M) which indicates the relationship between the glucose amount infused with a hyperinsulinemia, to maintain glycemia values of 100 mg/dL, being the standard value 1 for this relationship (in the age group under 25 and 90-110 % of ideal weight). The sample was composed by 16 permanent residents for more than 5 years in each city, with a body mass index (BMI) between 20 and 25 kg/m2 and an age between 20 and 25. Results: We found that the hepatic sensitivity to the insulin was significantly higher (P <0.05) and the permanent resident from the highaltitude (m value M=1,5231, SD=0.3388) compared to the sea level permanent resident (m value M=1,1092, SD=0,2310). Conclusions: We propose that this is due to a physiological and metabolic adaptation at the conditioned height by the hypoxia and the atmospheric pressure.References
1. Woolcott O, Castillo O. Metabolismo de la glucosa en el habitante de la altura: Replanteando evidencias. Arch Biol Andina. 2008; 14(1): 51-62.
2. San Martín M. Distribución de la glucosa sanguínea y su variación con el cambio de altitud. An Fac Med. 1940; 23(1):312-318.
3. Monge CC. Glucosa, ácido láctico y ácido pirúvico a nivel del mar y en la altura. An Fac Med. 1949; 32(1): 60-65.
4. Picón-Reátegui E. Studies on the metabolism of carbohydrates at sea level and at high altitudes. Metabolism. 1962; 11(11): 48-54.
5. Picón-Reátegui E. Intravenous glucose tolerance test at sea level and at high altitudes. J Clin Endocrinol Metab. 1963; 23(1): 1256-1261.
6. Calderón R, Llerena A. Carbohydrate metabolism in people living in chronic hypoxia. Diabetes. 1965; 14(1): 100-105.
7. Garmendia F. Glicemia del nativo normal de altura. Arch Inst Biol Andina. 1970; 3(2): 09-16.
8. Heat D, Williams D. Man at high altitude: the pathophysiology of acclimatization and adaptation. 1ª ed. New York: Churchill Livingstone: 1981.
9. Castillo O, Woolcott Oscar, Gonzáles V, Tello L, Villarreal C, et al. Monitoreo continuo de la glicemia en el poblador de los andes. Diagóstico. 2006; 45(1):39-43.
10. Garmendia F, Torres J, Tamayo R, Urdanivia E. Carbohydrate metabolism at high altitude. Abstract book of the 8th Congress of the International Diabetes Federation. Brussels, Belgium. 1973; 262(1): 15-20.
11. Cartee G. Douen AG, Ramlal T, Klip A, Holloszy JO. Stimulation of glucose transport in skeletal muscle by hypoxia. J Appl Physiol. 1991; 70(4): 593-600.
12. Azevedo J, Carey J, Pories W, Morris P, Lynis G. Hypoxia stimulates glucose transport in insulinresistant human skeletal muscle. Diabetes. 1995; 44(1):695-698.
13. Reynolds T, Brozinick J, Rogers MA, Cushman SW. Mechanism of hypoxiastimulated glucose transport in rat skeletal muscle: potential role of glycogen. Am J Physiol. 1998; 274:773-778.
14. Zhang J, Behrooz A, Ismail-Beigi F. Regulation of glucose transport by hypoxia. Am J Kidney Dis. 1999; 34(1):189-202.
15. Weickert M, Pfeiffer A. Signalling mechanisms linking hepatic glucose and lipid metabolism. Diabetologia. 2006; 49(8): 1732-41.
16. Bergman R. Non-esterified fatty acids and the liver: why is insulin secreted into the portal vein? Diabetologia. 2000; 43(7): 46-52.
17. Jiang G, Zhang B. Glucagon and regulation of glucose metabolism. Am J Physiol Endocrinol Metab. 1995; 284(4): 1-8.
18. Castillo O, Alzamora J, Capatinta C, et al. Insulin sensitivity at high altitude. Abstract book of the 5th European Congress of Endocrinology. 1998; 5(2):9-13.
19. Torres J. Sensibilidad a la insulina en altura y a nivel del mar. High Alt Med Biol. 2002; 3(1): 97-138.
20. Marticorena E. Entidades nosológicas de desadaptación aguda a la altura. An Fac Med Lima. 1997; 58(2): 85-91.
21. Consensus Development Conference on Insulin Resistance. 5-6 November 1997. American Diabetes. Association. Diabetes Care. 1998; 21(2): 310-314.
22. Pérez M, Montanya E. Técnicas para el estudio de la resistencia insulínica. Una valoración crítica. AV DIABETOL. 2001; 17(1): 179-186.
23. Cabezas-Cerrato J, Araujo D. Resistencia a la acción de la insulina. Evolución histórica del concepto. Técnicas para el estudio in vivo en humanos; 2004.
