Webber J, Whitelaw D, Smith J M, Nattrass M
Diabetes Clinic, University Hospital Birmingham NHS Trust, Selly Oak Hospital, UK.
Diabetes Obes Metab. 1999 May;1(3):173-8. doi: 10.1046/j.1463-1326.1999.00011.x.
To assess whether resistance to the effects of insulin on lipid metabolism in type 2 diabetes mellitus parallels that demonstrated for glucose metabolism.
Thirteen patients with type 2 diabetes were studied (mean age 56.2 years, mean body mass index (b.m.i.) 28.7 kg m(-2)). The hyperinsulinaemic euglycaemic clamp (2 mU insulin kg(-1) min(-1)) and a low-dose insulin infusion technique were used in order to assess insulin effects on both glucose and lipid metabolism.
Using the low-dose insulin infusion there were significant correlations between measures of insulin sensitivity for glucose metabolism and those for NEFA (r = 0.82, p < 0.01) and glycerol (r = 0.73, p < 0.01). Mean clamp glucose disposal was 33.4 micromol kgb.w.(-1) min(-1). There was no correlation between clamp glucose disposal and insulin sensitivity derived from the low-dose insulin infusion.
At low insulin concentrations, insulin's effects on glucose metabolism (mainly suppression of hepatic glucose output) mirror those on inhibition of lipolysis. At the high insulin concentrations seen during the clamp, stimulation of glucose uptake provides a measure of maximal insulin action which does not parallel its physiological effects shown at lower concentrations.
评估2型糖尿病患者胰岛素抵抗对脂质代谢的影响是否与对葡萄糖代谢的影响相似。
对13例2型糖尿病患者进行研究（平均年龄56.2岁，平均体重指数（b.m.i.）28.7 kg m⁻²）。采用高胰岛素正常血糖钳夹技术（2 mU胰岛素·kg⁻¹·min⁻¹）和低剂量胰岛素输注技术，以评估胰岛素对葡萄糖和脂质代谢的影响。
使用低剂量胰岛素输注时，葡萄糖代谢的胰岛素敏感性指标与非酯化脂肪酸（NEFA）（r = 0.82，p < 0.01）和甘油（r = 0.73，p < 0.01）的胰岛素敏感性指标之间存在显著相关性。钳夹期间平均葡萄糖处置率为33.4 μmol·kg体重⁻¹·min⁻¹。钳夹葡萄糖处置率与低剂量胰岛素输注得出的胰岛素敏感性之间无相关性。
在低胰岛素浓度下，胰岛素对葡萄糖代谢的影响（主要是抑制肝葡萄糖输出）与抑制脂肪分解的影响相似。在钳夹期间所见的高胰岛素浓度下，刺激葡萄糖摄取提供了最大胰岛素作用的一种衡量指标，这与较低浓度下显示的生理效应并不平行。
