Edge J A, Matthews D R, Dunger D B
Department of Paediatrics, John Radcliffe Hospital, Oxford, UK.
Diabetes Res. 1990 Nov;15(3):109-12.
The study was undertaken to determine whether overnight insulin requirements were being met during conventional insulin therapy in adolescents with IDDM. Overnight glucose and insulin profiles were compared when the subjects were on their usual insulin regime (baseline) and when the blood glucose was clamped using a variable rate insulin infusion (clamp). Thirteen adolescents (5 boys and 8 girls, median age 12.2 yr; range 10.5-15.4 yr; Median HBA1 11.4%; range 8.4-15.6) took part in the study. Three were on twice daily, two on multiple injection therapy and two on once daily insulin therapy. During the baseline studies, blood glucose concentrations fell to a nadir at 0200-0400 hr and then rose during the early hours of the morning. The clamp studies confirmed that the insulin requirement for euglycaemia was higher between 0500 and 0800 hr (15.4 +/- 0.9 mU/kg/hr) than between 0100 and 0400 (12.1 +/- 1.1 mU/kg/hr; p = 0.002). Comparison of the free insulin concentrations between the baseline and clamp nights, indicated that during the baseline study subjects were relatively over-insulinized during the early part of the night and under-insulinized during the latter part of the night irrespective of what insulin regime they were receiving. We conclude that current insulin regimes do not provide appropriate insulin delivery for the control of blood glucose during puberty.
本研究旨在确定在常规胰岛素治疗期间，胰岛素依赖型糖尿病（IDDM）青少年的夜间胰岛素需求是否得到满足。比较了受试者在常规胰岛素治疗方案（基线）下以及使用可变速率胰岛素输注进行血糖钳夹时（钳夹）的夜间血糖和胰岛素曲线。13名青少年（5名男孩和8名女孩，中位年龄12.2岁；范围10.5 - 15.4岁；中位糖化血红蛋白（HBA1）11.4%；范围8.4 - 15.6）参与了该研究。其中3人接受每日两次胰岛素治疗，2人接受多次注射治疗，2人接受每日一次胰岛素治疗。在基线研究期间，血糖浓度在02:00 - 04:00时降至最低点，然后在清晨时段上升。钳夹研究证实，维持正常血糖所需的胰岛素剂量在05:00至08:00时（15.4±0.9 mU/kg/hr）高于01:00至04:00时（12.1±1.1 mU/kg/hr；p = 0.002）。比较基线和钳夹夜间的游离胰岛素浓度表明，在基线研究期间，无论接受何种胰岛素治疗方案，受试者在夜间早期相对胰岛素过量，而在夜间后期胰岛素不足。我们得出结论，目前的胰岛素治疗方案在青春期不能为控制血糖提供适当的胰岛素剂量。
