Uthoff H, Lehmann R, Sprenger M, Wiesli P
Department of Internal Medicine, Endocrinology and Diabetes, Kantonsspital Frauenfeld, Frauenfeld, Switzerland.
Exp Clin Endocrinol Diabetes. 2010 May;118(5):325-7. doi: 10.1055/s-0029-1241199. Epub 2010 Jan 12.
Basal insulin dose requirements in patients with type 1 diabetes may be derived from the course of glucose concentrations in the fasting state; i. e. by skipping meals. The present study examined whether fasting tests could be replaced by carbohydrate-free meals.
16 adult patients with type 1 diabetes (10 male) on intensive insulin therapy participated in this prospective intervention study. Mean age (+/-SD) was 44+/-12 years, BMI 24+/-3 kg/m (2), mean HbA1c was 7.5+/-0.6% and duration of diabetes 15+/-12 years. All participants skipped dinner and plasma glucose concentrations were hourly monitored from 7 p.m. to 11 p.m. This blood glucose profile was compared with three test meals given at 7 p.m. at day 2-4, consumed either in the hospital (meal 1) or at home (meal 2 and 3). No insulin injection (except to basal insulin) was allowed. Test meals consisted of 2.5 g carbohydrate, 32.4 g protein, 52.0 g fat (according to 612 kcal).
During 16 fasting tests plasma glucose concentration remained stable between 7.2+/-2.4 mmol/l at 7 p.m. and 6.8+/-2.8 mmol/l at 11 p.m. (p=0.461). Following the intake of near carbohydrate-free meals (48 tests), plasma glucose concentrations rose within 4 h from 6.7+/-2.0 at 7 p.m. to 9.8+/-3.4 mmol/l at 11 p.m. (p<0.0001). The increase in plasma glucose concentrations was similar in all three different meals tested.
Plasma glucose concentrations significantly increase in patients with type 1 diabetes following the intake of carbohydrate-free meals. Carbohydrate-free meal-tests cannot replace skipping meal tests to determine the basal insulin requirement in patients with type 1 diabetes.
1型糖尿病患者的基础胰岛素剂量需求可根据空腹状态下的血糖浓度变化过程得出；即通过不进食来实现。本研究探讨了无碳水化合物餐是否可以替代空腹试验。
16名接受强化胰岛素治疗的成年1型糖尿病患者（10名男性）参与了这项前瞻性干预研究。平均年龄（±标准差）为44±12岁，体重指数为24±3kg/m²，平均糖化血红蛋白为7.5±0.6%，糖尿病病程为15±12年。所有参与者晚餐不进食，并于晚上7点至11点每小时监测一次血浆葡萄糖浓度。将该血糖曲线与第2 - 4天晚上7点提供的三份试验餐进行比较，试验餐分别在医院（餐1）或家中（餐2和餐3）食用。除基础胰岛素外，不允许注射其他胰岛素。试验餐包含2.5克碳水化合物、32.4克蛋白质、52.0克脂肪（相当于612千卡）。
在16次空腹试验中，血浆葡萄糖浓度在晚上7点时为7.2±2.4毫摩尔/升，晚上11点时为6.8±2.
