Gluconeogenesis and the Cori cycle in 12-, 20-, and 40-h-fasted humans.

Six subjects were infused with [U-13C]glucose (0.03-0.05 mg ⋅ kg-1 ⋅ min-1) starting 8-9 h after a meal, and the production of glucose, the recycling of glucose (the Cori cycle), the dilution of glucose by unlabeled carbon into the hepatic lactate-pyruvate pool, and gluconeogenesis were determined in these fasted volunteers by use of mass isotopomer analysis and equations previously described [J. A. Tayek and J. Katz. Am. J. Physiol.272 ( Endocrinol. Metab. 35): E476-E484, 1997]. A primed continuous 11-h infusion was started at 6:00 AM, and the above parameters were calculated after 3 h (for the 12-h fast) and at the end of the infusion (for the 20-h fast). Another group of five subjects was fasted for 40 h, and the above parameters were calculated as before. At 12, 20, and 40 h of fasting, respectively, blood glucose was 93 ± 2, 83 ± 2, and 71 ± 2 (SE) mg/dl; glucose production was 2.3, 1.8, and 1.77 mg ⋅ kg-1 ⋅ min-1; the recycling of labeled carbon was 8, 15, and 15%, and that of glucose molecules (Cori cycle) was 18, 35, and 36%; the contribution of gluconeogenesis to glucose production was 41, 71, and 92% or 0.96, 1.29, and 1.64 mg ⋅ kg-1 ⋅ min-1; and the contribution of other sources to glucose production was 1.37, 0.53, and 0.15 mg ⋅ kg-1 ⋅ min-1. The recycling of glucose is important in prolonged fasting for the maintenance of plasma glucose concentration. We demonstrate here that gluconeogenesis can be easily measured and that it accounts for ∼90% of glucose production after a 40-h fast.