Failure of hyperketonemia to alter basal and insulin-mediated glucose metabolism in man

The effect of physiologic elevations of plasma hydroxybutyrate induced by the infusion of sodium D,L-β-hydroxybutyrate (15 μmol·kg^-1·min^-1) on carbohydrate metabolism was examined with the euglycemic insulin clamp technique in nine healthy volunteers. Plasma insulin concentration was acutely raised and maintained at 126 ± 6 μU/ml and plasma glucose was held constant at the fasting level by a variable glucose infusion. Glucose uptake of 6.53 ± 0.80 mg·kg^-1·min^-1 was unchanged by hyperketonemia when compared with an intraindividual control study using saline instead of β-OH-butyrate infusion (6.26 ± 0.59 mg·kg^-1·min^-1). In studies, in which the degree of metabolic alkalosis accompanying butyrate infusion was mimicked by the continuous administration of bicarbonate, glucose uptake was also unaffected (6.25 ± 0.45 mg·kg^-1·min^-1). Furthermore, hyperketonemia had no effect on basal glucose production or the suppression of hepatic glucose production following hyperinsulinemia. It is concluded that moderate elevations in plasma β-hydroxy-butyrate do not alter hepatic or peripheral glucose metabolism.