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Hvidovre Hospital - en del af Københavns Universitetshospital

Impact of prolonged fasting on insulin secretion, insulin action and hepatic versus whole-body insulin secretion disposition indices in healthy young males

Publikation: Bidrag til tidsskriftTidsskriftartikelpeer review


  • Sine Wanda Jørgensen
  • Line Hjort
  • Linn Gillberg
  • Louise Justesen
  • Sten Madsbad
  • Charlotte Brøns
  • Allan Vaag
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The extent to which reduced insulin secretion during prolonged fasting reflects failure to compensate for whole body insulin resistance or a normal adjustment to potentially increased hepatic insulin action is unknown. We examined the effects of 36- versus 12-h fasting on insulin secretion and whole body versus hepatic insulin action in 13 healthy young males. Hepatic glucose production and insulin action were studied using stable isotopes, whereas whole body insulin action and insulin secretion were studied using an intravenous glucose tolerance test (IVGTT) and minimal modeling. Insulin, glucose, and lipid profiles were subsequently measured during a refeeding meal test. Prolonged fasting caused a minor reduction of first-phase insulin secretion in a context of improved hepatic insulin action, contrasting an increase in whole body insulin resistance. Accordingly, prolonged fasting was associated with opposite-directed effects on hepatic versus whole body insulin secretion disposition indices. Thirty-six-hour fasting compared with 12-h fasting was associated with increased serum insulin levels during the refeeding meal test. In conclusion, reduced insulin secretion during prolonged fasting may represent a healthy response to improved hepatic insulin action. Use of insulin secretion disposition indices without taking organ-specific insulin action into account may lead to erroneous conclusions. NEW & NOTEWORTHY Thirty-six-hour prolonged, compared with 12-h overnight fasting, is associated with slightly reduced first-phase insulin secretion in the face of opposite-directed changes in hepatic versus whole body insulin action in healthy young males. The paradoxical finding of increased hepatic versus decreased whole body insulin secretion disposition indices during prolonged fasting challenges the physiological understanding and validity of insulin secretion disposition indices not taking organ-specific insulin action into account.

TidsskriftAmerican Journal of Physiology: Endocrinology and Metabolism
Udgave nummer2
Sider (fra-til)E281-E290
StatusUdgivet - 1 feb. 2021

Bibliografisk note

Funding Information:
The study was funded by the European Foundation for the Study of Diabetes (EFSD), The Danish Council for Strategic Research, Novo Nordisk Fonden, The Danish Diabetes Academy supported by the Novo Nordisk Foundation, The Augustinus Foundation, and The European Union 6th Framework EXGENESIS grant.

ID: 61426860