Multiorgan Insulin Sensitivity in Lean and Obese Subjects

OBJECTIVE-To provide a comprehensive assessment of multiorgan insulin sensitivity in lean and obese subjects with normal glucose tolerance. RESEARCH DESIGN AND METHODS-The hyperinsulinemic-euglycemic clamp procedure with stable isotopically labeled tracer infusions was performed in 40 obese (BMI 36.2 +/- 0.6 kg/m(2), mean +/- SEM) and 26 lean (22.5 +/- 0.3 kg/m(2)) subjects with normal glucose tolerance. Insulin was infused at different rates to achieve low, medium, and high physiological plasma concentrations. RESULTS-In obese subjects, palmitate and glucose R-a in plasma decreased with increasing plasma insulin concentrations. The decrease in endogenous glucose R-a was greater during low-, medium-, and high-dose insulin infusions (69 +/- 2, 74 +/- 2, and 90 +/- 2%) than the suppression of palmitate R-a (52 +/- 4, 68 +/- 1, and 79 +/- 1%). Insulin-mediated increase in glucose disposal ranged from 24 +/- 5% at low to 253 +/- 19% at high physiological insulin concentrations. The suppression of palmitate R-a and glucose R-a were greater in lean than obese subjects during low-dose insulin infusion but were the same in both groups during high-dose insulin infusion, whereas stimulation of glucose R-d was greater in lean than obese subjects across the entire physiological range of plasma insulin. CONCLUSIONS-Endogenous glucose production and adipose tissue lipolytic rate are both very sensitive to small increases in circulating insulin, whereas stimulation of muscle glucose uptake is minimal until high physiological plasma insulin concentrations are reached. Hyperinsulinemia within the normal physiological range can compensate for both liver and adipose tissue insulin resistance, but not skeletal muscle insulin resistance, in obese people who have normal glucose tolerance.