Mechanism of growth hormone-induced postprandial carbohydrate intolerance in humans

Growth hormone excess can cause postprandial carbohydrate intolerance. To determine the contribution of splanchnic and extrasplanchnic tissues to this process, subjects were fed an isotopically labeled mixed meal after either a 12-h infusion of saline or growth hormone (4 μg·kg^-1·min^-1). Growth hormone infusion resulted in higher glucose and insulin concentrations both before and after meal ingestion. Despite growth hormone-induced hyperglycemia and hyperinsulinemia, postprandial hepatic glucose release and carbon dioxide incorporation into glucose (a qualitative estimate of gluconeogenesis) were similar to those present during saline, suggesting altered hepatic regulation. This was confirmed when glucose was infused in the absence of growth hormone to achieve glucose (and insulin) concentrations comparable to those present during growth hormone infusion. Although growth hormone excess did not alter splanchnic uptake of ingested glucose, it resulted in a fivefold increase in postprandial hepatic glucose release (578 ± 31 vs. 117 ± 10 mg·kg^-1·6 h^-1, P < 0.01), less suppression of carbon dioxide incorporation into glucose (-13 ± 9 vs. -53 ± 12 mg·kg^-1·6 h^-1, P < 0.01), and lower glucose uptake (1,130 ± 59 vs. 1,850 ± 150 mg·kg^-1·6 h^-1, P < 0.01). The decrease in postprandial glucose uptake did not appear to be mediated by a change in substrate uptake since postprandial plasma concentrations and forearm balance of lactate, free fatty acids, and ketone bodies did not differ in the presence and absence of growth hormone excess. We conclude that growth hormone excess causes carbohydrate intolerance by increasing postprandial hepatic release at least in part by impairing suppression of gluconeogenesis and by decreasing postprandial glucose uptake.