Assessment of glucose metabolism in humans with the simultaneous use of indirect calorimetry and tracer techniques.

Concomitant measurements of sytemic glucose delivery and carbohydrate oxidation are frequently performed in human investigations. Systemic glucose delivery (SGD) is usually determined using dilution of infused glucose tracers; net carbohydrate oxidation rate (net CHOOX) can be calculated from respiratory gas exchanges and urinary nitrogen excretion (indirect calorimetry); alternatively, glucose oxidation can be measured from labelled CO2 production during infusion of carbon-labelled glucose tracers. In this paper, the theory underlying the use of each of these techniques is briefly reviewed and qualitative differences are outlined. SGD represents the sum of hepatic glucogenolysis, gluconeogenesis from amino acids or glycerol, and, according to the glucose tracer used, glucose cycles (glucose-phosphate cycle, fructose-phosphate cycle, Cori and glucose-alanine cycles); systemic delivery of exogenous glucose after oral or i.v. glucose administration is also measured. Net CHOOX represents oxidation of glucose arising from hepatic or muscle glycogen or from exogenous glucose; it does not take into account oxidation of glucose formed from amino acids or glycerol, which is included in net protein or lipid oxidation. In contrast, isotopic determination of glucose oxidation corresponds to oxidation of glucose originating from hepatic glycogen breakdown, of exogenously administered glucose, and of glucose formed from amino acids and glycerol. Non-oxidative glucose disposal, calculated as SGD-net CHOOX, corresponds to the sum of gluconeogenesis from amino acids or glycerol (which are included in net protein and lipid oxidation), glucose cycles, and glycogen synthesis.