Evaluation of ethanol hypoglycemia in man: Turnover studies with C-6 14C glucose

Abstract Glucose turnover (supply and utilization) was studied prior to and following the administration of alcohol to obese human subjects and human subjects of normal weight fasted for 3 days. Hypoglycemia was observed in all subjects. The rate of decrease in glucose concentration was significantly greater in subjects of normal weight than in obese subjects. It has been demonstrated that this difference is due to an average increase in the rate of glucose utilization in subjects of normal weight versus an average decline in the rate of glucose utilization in obese subjects during the production of hypoglycemia. The alterations observed in glucose supply and utilization were complex. Immediately following the initiation of the ethanol infusion, the rate of glucose utilization rose sharply in every individual. During this same period (0–35 min following alcohol) the rate of glucose supply rose in all but one individual in each group. In the subsequent portion of the period of production of hypoglycemia, glucose supply (presumably gluconeogenesis) was inhibited in every case. During this period, the rate of glucose utilization was observed to be greater than prealcohol rates in the individuals of normal weight, while in the obese individuals a decline was observed in the rate of glucose utilization compared to that observed prior to alcohol. In the final hours of these studies, a second steady state (constant low blood glucose concentration) was observed. The kinetics of glucose supply and utilization in the transition from progressive hypoglycemia to this terminal phase were again complex. All, but one individual, were found to have increased their rates of glucose supply over the inhibited rates observed during the production of hypoglycemia. At the same time, the rate of peripheral glucose utilization fell in every individual, ranging from a barely perceptible fall in the obese group to an average decrease of 40% in the individuals whose weight was normal. These studies indicate that there are factors other than inhibition of gluconeogenesis that contribute to the degree of hypoglycemia after alcohol in man fasted 72 hr.