Table 1413

Clinical Studies on Insulin

Stimulates muscle protein synthesis in catabolic burn patients Stimulates muscle protein synthesis in healthy humans Decreases protein breakdown in catabolic patients Increases re-epithelialization rate of donor sites in burn patients

Wound Healing Effect

Less data exist on the actions of insulin on wound healing over and above its systemic anabolic effect.93-96 Increases in skin protein content have been demonstrated with a chronic insulin infusion. Increased re-epithelialization of skin graft donor sites was reported in one clinical trial in burn patients. Several animal studies have demonstrated increased collagen production with insulin and increasing the insulin administration to diabetic mice improved all phases of healing.98 However, the effects of insulin on wound healing have not been well studied in man (Table 14.12).

Complications

The main complication is hypoglycemia. There does not appear to be any fluid retention or hypermetabolism with its use.

Summary

In summary, hyperinsulinemia in catabolic patients and in normal adults increases net protein synthesis and decreases protein breakdown. An infusion of glucose is required to avoid hypoglycemia. In turn, inadequate insulin intake in diabetics leads to progressive lean mass loss, and hyperglycemia appears to accentuate the nitrogen loss. Although some positive data are present on insulin improving healing, data are limited.

testosterone

Actions

Testosterone, with a basic structure as a steroid ring, is the natural endogenous androgen.97-99 Testosterone is synthesized primarily in the Leydig cells of the testes in males and by the ovaries and adrenal glands in females. Healthy adult men produce 3 to 10 mg/d, yielding plasma concentrations ranging from 300 to 1000 |J.g/dl.93-95 Testosterone acts on the cell androgenic receptors found mainly in skin, muscle, and male sex glands. It has both androgenic or masculinizing properties and anabolic properties. Androgenic effects are present to some degree in all anabolic steroids. Androgenic affects include development of male sex glands, male hair growth pattern, increased libido, and assertiveness (Table 14.14). Most testosterone analogs or anabolic steroids have androgenic properties much lower than testosterone

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