Kamel A, Norgren S, Persson B, Marcus C
Department of Pediatrics, Huddinge University Hospital, Sweden.
Arch Dis Child. 1999 Jan;80(1):42-5. doi: 10.1136/adc.80.1.42.
To investigate the dynamics between plasma and dialysate glucose during hypoglycaemia in children.
Six children in prepuberty or early puberty were investigated by multiple blood sampling and microdialysis of subcutaneous adipose tissue during a standard arginine-insulin tolerance test. Glucose and glycerol, as an index of lipolysis, were measured in samples from both compartments. Plasma concentrations of insulin and the main counterregulatory hormones were also measured.
Plasma and dialysate glucose concentrations were very similar at baseline and increased in concert after infusion of arginine, probably in response to glucagon release. After insulin injection, glucose in both plasma and dialysate fell in parallel. The subsequent hypoglycaemic stress response induced a rapid rebound in the plasma concentration with a mean (SD) delay in the dialysate of 16 (3) minutes. Plasma glycerol was approximately fivefold lower than in the dialysate and did not fluctuate significantly. Dialysate glycerol decreased with arginine infusion and reached a nadir immediately following insulin administration. Subsequently, the antilipolytic effect of insulin was overcome by the hypoglycaemic stress response, and lipolysis prevailed in spite of hyperinsulinaemia.
After rapidly induced hypoglycaemia, rebound of interstitial glucose concentrations is significantly delayed compared with plasma concentrations, and the antilipolytic effect of hyperinsulinaemia is opposed possibly by the hypoglycaemic stress response.
研究儿童低血糖期间血浆与透析液葡萄糖之间的动态变化。
在标准精氨酸 - 胰岛素耐量试验期间，对6名青春期前或青春期早期儿童进行多次采血及皮下脂肪组织微透析。检测两个部位样本中的葡萄糖和作为脂肪分解指标的甘油。同时测定血浆中胰岛素及主要的对抗调节激素浓度。
基线时血浆和透析液葡萄糖浓度非常相似，输注精氨酸后两者浓度同步升高，这可能是对胰高血糖素释放的反应。注射胰岛素后，血浆和透析液中的葡萄糖均平行下降。随后的低血糖应激反应导致血浆浓度迅速反弹，透析液中的平均（标准差）延迟时间为16（3）分钟。血浆甘油比透析液中低约五倍，且波动不明显。透析液甘油随着精氨酸输注而降低，并在胰岛素给药后立即达到最低点。随后，低血糖应激反应克服了胰岛素的抗脂解作用，尽管存在高胰岛素血症，脂肪分解仍占主导。
快速诱导低血糖后，间质葡萄糖浓度的反弹与血浆浓度相比明显延迟，高胰岛素血症的抗脂解作用可能被低血糖应激反应所抵消。
