Monti L D, Piatti P M, Home P D, Tomson C, Alberti K G
Human Metabolism Research Centre, University of Newcastle upon Tyne, U.K.
Diabetes Res Clin Pract. 1992 Mar;15(3):237-44. doi: 10.1016/0168-8227(92)90030-u.
Patients with type 1 diabetes are usually given insulin subcutaneously, but this does not mimic the physiological route of pancreatic insulin release, which may be better achieved with intraperitoneal insulin. Five C-peptide negative type 1 diabetic patients were studied on two occasions, once with intravenous (IV) and once with intraperitoneal (IP) insulin. Normoglycaemia was maintained from 1700 h with variable insulin infusion, and glucose turnover and recycling assessed from 0600 to 0800 h. A 4-h hyperinsulinaemic (25 mU kg-1 h-1) euglycaemic clamp was then performed, with IP or IV insulin delivery. During the night similar insulin infusion rates were needed to achieve equal blood glucose concentrations. Glucose turnover was identical (IV: 2.4 +/- 0.2 vs IP: 2.3 +/- 0.1 mg kg-1 min-1) (+/- SE) with glucose/carbon recycling 8.8 +/- 4.7 and 12.8 +/- 2.9% (NS). Blood lactate, pyruvate and alanine concentrations were significantly higher with IP than IV insulin (P less than 0.05). During the clamp, insulin concentration was 28 +/- 3 mU/l with IV insulin and 15 +/- 1 mU/l with IP insulin (P less than 0.05) and glucose requirement 2.0 +/- 0.5 and 0.8 +/- 0.3 mg kg-1 min-1, respectively (P less than 0.05). Glucose carbon recycling was higher with IP insulin (P less than 0.05). We conclude that: (1) in type 1 (insulin-dependent) diabetic patients hepatic glucose production could be normalized with both routes of insulin administration, and (2) at the same insulin infusion rate, the relative peripheral hypoinsulinaemia with IP route is sufficient to increase the rate of release of gluconeogenic precursors, or decrease their hepatic uptake.
1型糖尿病患者通常接受皮下胰岛素注射，但这并不能模拟胰腺胰岛素释放的生理途径，而腹腔内注射胰岛素可能能更好地实现这一点。对5名C肽阴性的1型糖尿病患者进行了两次研究，一次采用静脉注射（IV）胰岛素，另一次采用腹腔内（IP）胰岛素。从17:00开始通过可变胰岛素输注维持正常血糖水平，并在06:00至08:00评估葡萄糖周转和再循环。然后进行4小时的高胰岛素血症（25 mU kg-1 h-1）正常血糖钳夹试验，通过IP或IV途径输注胰岛素。夜间需要相似的胰岛素输注速率以达到相同的血糖浓度。葡萄糖周转率相同（IV：2.4±0.2对比IP：2.3±0.1 mg kg-1 min-1）（±标准误），葡萄糖/碳再循环分别为8.8±4.7%和12.8±2.9%（无显著性差异）。腹腔内注射胰岛素时血乳酸、丙酮酸和丙氨酸浓度显著高于静脉注射胰岛素（P<0.05）。在钳夹试验期间，静脉注射胰岛素时胰岛素浓度为28±3 mU/l，腹腔内注射胰岛素时为15±1 mU/l（P<0.05），葡萄糖需求量分别为2.0±0.5和0.8±0.3 mg kg-1 min-1（P<0.05）。腹腔内注射胰岛素时葡萄糖碳再循环更高（P<0.05）。我们得出结论：（1）在1型（胰岛素依赖型）糖尿病患者中，两种胰岛素给药途径均可使肝葡萄糖生成正常化；（2）在相同的胰岛素输注速率下，腹腔内注射途径导致的相对外周低胰岛素血症足以增加糖异生前体的释放速率或减少其肝脏摄取。
