Basu R, Basu A, Nielsen M, Shah P, Rizza R A
Division of Endocrinology, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Clin Endocrinol Metab. 1999 Jul;84(7):2314-9. doi: 10.1210/jcem.84.7.5860.
The ability of glucose to stimulate its own uptake and suppress its own release is impaired in type 2 diabetes. To determine whether glucose effectiveness is improved by short term euglycemia, 10 type 2 diabetic subjects were studied on 2 occasions. Insulin was infused throughout the night to maintain euglycemia (approximately 5 mmol/L), or glucose was permitted to remain at ambient hyperglycemic levels (approximately 10 mmol/L) until the following morning when euglycemia was achieved with a variable insulin infusion. A prandial glucose infusion (containing 35 g glucose) was started at 1000 h, and the variable insulin infusion was replaced by a constant infusion of insulin (0.25 mU/ kg x min), somatostatin (60 ng/kg x min), glucagon (0.65 ng/kg x min), and GH (3 ng/kg x min) to maintain hormone concentrations at constant basal levels. Although nocturnal glucose concentrations were (by design) higher (P<0.01) on the hyperglycemic than on the euglycemic study day (10.1+/-0.2 vs. 5.4+/-0.1 mmol/L), glucose concentrations did not differ either before (4.9+/-0.1 vs. 4.9+/-0.1 mmol/L) or during the prandial glucose infusion (peak, 11.1+/-0.5 vs. 11.3+/-0.5 mmol/L; incremental area, 1390+/-254 vs. 1409+/-196 mmol/L x 6 h). Furthermore, glucose-induced stimulation of glucose disappearance (2068+/-218 vs. 1957+/-244 micromol/kg x 6 h) and suppression of glucose production (-2253+/-378 vs. -2124+/-257 micromol/kg x 6 h) did not differ. Thus, restoration of euglycemia by means of an overnight insulin infusion does not alter glucose effectiveness in people with type 2 diabetes.
在2型糖尿病中，葡萄糖刺激自身摄取并抑制自身释放的能力受损。为了确定短期血糖正常是否能改善葡萄糖效能，对10名2型糖尿病患者进行了两次研究。整夜输注胰岛素以维持血糖正常（约5 mmol/L），或者允许葡萄糖保持在环境高血糖水平（约10 mmol/L），直到次日早晨通过可变胰岛素输注实现血糖正常。在10:00开始输注餐时葡萄糖（含35 g葡萄糖），可变胰岛素输注被胰岛素（0.25 mU/kg×min）、生长抑素（60 ng/kg×min）、胰高血糖素（0.65 ng/kg×min）和生长激素（3 ng/kg×min）的持续输注替代，以将激素浓度维持在恒定的基础水平。尽管在高血糖研究日夜间血糖浓度（按设计）高于血糖正常研究日（P<0.01）（10.1±0.2 vs. 5.4±0.1 mmol/L），但在输注餐时葡萄糖之前（4.9±0.1 vs. 4.9±0.1 mmol/L）或期间血糖浓度并无差异（峰值，11.1±0.5 vs. 11.3±0.5 mmol/L；增量面积，1390±254 vs. 1409±196 mmol/L×6 h）。此外，葡萄糖诱导的葡萄糖消失刺激（2068±218 vs. 1957±244 μmol/kg×6 h）和葡萄糖生成抑制（-2253±378 vs. -2124±257 μmol/kg×6 h）也无差异。因此，通过整夜胰岛素输注恢复血糖正常并不会改变2型糖尿病患者的葡萄糖效能。
