Intact glucose transport in morphologically altered denervated skeletal muscle from quadriplegic patients

The present study was undertaken to investigate the nature of the whole body insulin resistance that characterizes patients with complete cervical spinal cord lesion. Nine patients with C5-C7 lesions and ten age-matched healthy individuals were studied. Whole body insulin-mediated glucose utilization was reduced by 43% in the quadriplegic patients compared with the controls (P < 0.001). In the quadriplegic patients, lean body mass corresponded to 66 +/- 3% of total body mass. Despite whole body insulin resistance, in isolated vastus lateralis muscle, basal and insulin-stimulated 3-O-methylglucose transport, as well as protein expression of the insulin or exercise-regulatable glucose transporter, GLUT-4, and glycogen content were comparable between the patients and controls. Strikingly, muscle fiber area was reduced by 44% (P < 0.05), percentage of type IIb fibers was increased (P < 0.01), and there was a complete loss of type I fibers in the patients. In conclusion, the dissociation between whole body insulin-mediated glucose uptake and skeletal muscle glucose transport in quadriplegic patients primarily reflects the decreased muscle mass. Furthermore, these findings demonstrate a remarkable capacity of skeletal muscle to maintain an intact glucose transport system despite severe morphological alterations.