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The vascular actions of insulin control its delivery to muscle and regulate the rate-limiting step in skeletal muscle insulin action
Open accessAbstract
Evidence suggests that insulin delivery to skeletal muscle interstitium is the rate-limiting step in insulin-stimulated muscle glucose uptake and that this process is impaired by insulin resistance. In this review we examine the basis for the hypothesis that insulin acts on the vasculature at three discrete steps to enhance its own delivery to muscle: (1) relaxation of resistance vessels to increase total blood flow; (2) relaxation of pre-capillary arterioles to increase the microvascular exchange surface perfused within skeletal muscle (microvascular recruitment); and (3) the trans-endothelial transport (TET) of insulin. Insulin can relax resistance vessels and increase blood flow to skeletal muscle. However, there is controversy as to whether this occurs at physiological concentrations of, and exposure times to, insulin. The microvasculature is recruited more quickly and at lower insulin concentrations than are needed to increase total blood flow, a finding consistent with a physiological role for insulin in muscle insulin delivery. Microvascular recruitment is impaired by obesity, diabetes and nitric oxide synthase inhibitors. Insulin TET is a third potential site for regulating insulin delivery. This is underscored by the consistent finding that steady-state insulin concentrations in plasma are approximately twice those in muscle interstitium. Recent in vivo and in vitro findings suggest that insulin traverses the vascular endothelium via a trans-cellular, receptor-mediated pathway, and emerging data indicate that insulin acts on the endothelium to facilitate its own TET. Thus, muscle insulin delivery, which is rate-limiting for its metabolic action, is itself regulated by insulin at multiple steps. These findings highlight the need to further understand the role of the vascular actions of insulin in metabolic regulation.
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“In vitro and rodent studies show that aldosterone-induced mineralocorticoid activation impairs insulin sensitivity in adipocytes and skeletal muscle [40,41].”
From Insulin sensitivity and pancreatic β-cell function in patients with primary aldosteronism (2021) · cites this paper as [41]
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“endothelial dysfunction 48 with consequent blunting of physiological vasodilation.49”
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Metadata
- Authors
- Barrett, E. J., Eggleston, E. M., Inyard, A. C., Wang, H., Li, G., Chai, W., & Liu, Z.
- Affiliations
- University of Virginia Health System (US)
- Corresponding author
- Barrett, E. J.
- Venue
- Diabetologia
- Published
- 2009-03-13
- Volume
- 52
- Issue
- 5
- Pages
- 752-764
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- PMC
- PMC2704146
- OpenAlex
- W2033746638
- Semantic Scholar
- 1734beade6892acf92cbb3b6f1dfe6b7bf05b1ef
- Cited by
- 323
- References
- 97
- Citations by year
- 2026: 12 · 2025: 7 · 2024: 9 · 2023: 9 · 2022: 14 · 2021: 19 · 2020: 13 · 2019: 18 · 2018: 10 · 2017: 19 · 2016: 15 · 2015: 20 · 2014: 19 · 2013: 51 · 2012: 29
- FWCI
- 3.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- University of Virginia
- University College London
- Vrije Universiteit Amsterdam
- National Institutes of Health (5p30dk063609-05, RR-00847)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK073759, R01DK073759, DK057878, DK-063609, P30-DK-063609, R01DK057878)
- National Center for Research Resources (RR 00847, M01RR000847)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- insulin, skeletal muscle, insulin delivery, resistance vessels, blood flow, insulin resistance, nitric oxide synthase, obesity, diabetes mellitus, muscle glucose uptake, endothelium
- MeSH terms
- Animals, Glucose, Homeostasis, Humans, Hyperinsulinism, Insulin, Insulin Resistance, Kinetics, Microcirculation, Glucose Clamp Technique, Microdialysis, Muscle, Skeletal
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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