Influence of nervous blockade on insulin-mediated glucose uptake in the human forearm

This study was undertaken to investigate if a nonpharmacologic increase in forearm blood flow (FBF) could increase forearm glucose uptake (FGU) during hyperinsulinemia. In 10 young volunteers, FBF and the arterial-venous glucose difference were measured in both arms during a 2-hour euglycemic hyperinsulinemic clamp procedure when 1 of the arms was subjected to axillary plexus nervous blockade with local anesthesia. FBF was measured in both arms by venous occlusion plethysmography. Nervous blockade, increasing FBF by more than 3-fold, did not improve insulin-mediated FGU. On the contrary, a tendency towards a reduced FGU compared with the control arm was seen (P =.07). Furthermore, while insulin increased FBF to a similar degree in both arms (+ 3.0 and 4.4 mL/min/100 mL tissue, P <.01 for both arms), nervous blockade abolished the rapid increase in glucose extraction seen in the control arm when insulin infusion was initiated. The present study showed that an increase in FBF induced by nervous blockade did not increase insulin-mediated FGU. On the contrary, a tendency towards a reduction was seen. Furthermore, insulin induced vasodilation in the blocked arm, but delayed the ability of insulin to promote glucose extraction, suggesting that the well-documented increase in skeletal muscle sympathetic nerve activity seen during acute hyperinsulinemia has metabolic rather than hemodynamic consequences.