Protein and energy metabolism in type 1 diabetes

doi:10.1016/j.clnu.2009.09.001

Clinical Nutrition

Volume 29, Issue 1, February 2010, Pages 13-17

https://doi.org/10.1016/j.clnu.2009.09.001 Get rights and content

Summary

Profound metabolic changes occur in people with type 1 diabetes mellitus during insulin deprivation. These include an increase in basal energy expenditure and reduced mitochondrial function. In addition, protein metabolism is significantly affected during insulin deprivation. A greater increase in whole-body protein breakdown than protein synthesis occurs resulting in a net protein loss. During insulin deprivation the splanchnic bed has a net protein accretion which accounts for the total increase in whole-body protein synthesis while muscle is in a net catabolic state.

Introduction

In the absence of insulin replacement type 1 diabetes is a catabolic condition with severe depletion of both energy stores and protein mass. Since most type 1 diabetic individuals are treated with insulin, a short period of insulin withdrawal in these individuals provides a model system to study the role of insulin in energy and protein metabolism. The causes of negative energy balance and protein catabolism have been extensively studied in people with type 1 diabetes and will be reviewed in this article.

Section snippets

Energy metabolism in type 1 diabetes

Profound changes in energy metabolism occur in people with type 1 diabetes mellitus (T1DM) during insulin deprivation in addition to the well known increase in plasma glucose. When glucose levels exceed renal threshold glycosuria and associated water loss occur. Glucose loss in urine will contribute to negative energy balance. Negative energy balance occurs in insulin deficient states in these diabetic people despite a relative increase in energy intake. These clinical observations are the

Protein metabolism in type 1 diabetes

The regulation of protein synthesis and breakdown is a central component of metabolic and physiological homeostasis.¹² Type 1 diabetic people are in a profound protein catabolic state without insulin replacement. The role of insulin in protein metabolism has been investigated in whole-body, regional and individual protein studies.

An increase in both whole-body protein breakdown and synthesis occurs in poorly controlled type 1 diabetic people. This increase in protein breakdown is greater than

Protein and energy metabolism in Asian Indians and type 2 diabetes

While most studies indicate that insulin positively regulates mitochondrial function, Asian Indians show a dissociation between mitochondrial ATP production and insulin sensitivity.²⁷ Similarly, caloric restriction improves insulin sensitivity and reduces intramuscular triglycerides, but does not increase energy metabolism or mitochondrial functions.²⁸ The interaction between insulin resistance in specific organs and energy metabolism remains to be fully understood. Asian Indians have enhanced

Summary

The changes in both energy and protein metabolism in type 1 diabetic people without insulin replacement are extensive. Insulin treatment returns their increased energy expenditure to normal levels and retains mitochondrial function. In addition, insulin treatment reduces whole-body and muscle protein breakdown and stimulates the synthesis of select individual proteins including muscle mitochondrial proteins. The increase in splanchnic protein synthesis that occurs with insulin deprivation needs

Conflict of Interest

The authors have no conflicts of interest to report.

Statement of authorship

SLH and KSN drafted the manuscript. All authors read and approved the final manuscript.

Acknowledgments

The studies are supported by grants from the National Institute of Health R01 DK41973 and UL1 RR02415-01.

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^☆: Conference presentation: 2008 Protein Symposium, Padua, Italy.

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ReviewProtein and energy metabolism in type 1 diabetes☆

Summary

Introduction

Section snippets

Energy metabolism in type 1 diabetes

Protein metabolism in type 1 diabetes

Protein and energy metabolism in Asian Indians and type 2 diabetes

Summary

Conflict of Interest

Statement of authorship

Acknowledgments

J Biol Chem

J Nutr

Metabolism

Am J Med

Role of hyperglucagonemia in catabolism associated with type 1 diabetes: effects on leucine metabolism and the resting metabolic rate

Diabetes

Effect of insulin deprivation on muscle mitochondrial ATP production and gene transcript levels in type 1 diabetic subjects

Diabetes

Increased energy expenditure in poorly controlled type 1 (insulin-dependent) diabetic patients

Diabetologia

Effects of low-dose and high-dose glucagon on glucose production and gluconeogenesis in humans

Metabolism

Hyperglucagonemia increases resting metabolic rate in man during insulin deficiency

J Clin Endocrinol Metab

Protein dynamics in whole body and in splanchnic and leg tissues in type I diabetic patients

J Clin Invest

Effect of poor diabetic control and obesity on whole body protein metabolism in man

Diabetologia

Relationship of resting metabolic rate to body composition and protein turnover

Am J Physiol

Effect of insulin on human skeletal muscle mitochondrial ATP production, protein synthesis, and mRNA transcripts

Proc Natl Acad Sci USA

Tissue-specific regulation of mitochondrial and cytoplasmic protein synthesis rates by insulin

Diabetes

Whole body protein synthesis and breakdown

Hyperglucagonemia during insulin deficiency accelerates protein catabolism

Am J Physiol

Review
Protein and energy metabolism in type 1 diabetes☆