Hother-Nielsen O, Beck-Nielsen H
Hvidöre Hospital, Klampenborg, Denmark.
Diabetologia. 1990 Oct;33(10):603-10. doi: 10.1007/BF00400204.
Using primed-continuous 3-3H-glucose infusion, basal glucose production rate has been reported to be 140% higher than normal or almost normal in hyperglycaemic patients with Type 2 (non-insulin-dependent) diabetes mellitus. To determine whether these markedly different results could be due to the mode of priming: fixed or adjusted, or the mode of calculation: steady state or non-steady state equations, we studied 11 patients with Type 2 diabetes (fasting plasma glucose 8-20 mmol/l). For 6 h 3-3H-glucose (0.40 microCi/min) was infused preceded by a priming dose of 40 microCi (fixed priming), or 40 microCi.plasma glucose (mmol/l).5(-1) (adjusted priming). In diabetic patients the plasma glucose concentration was not constant but declined 0.52 +/- 0.07 mmol.l-1.h-1. Furthermore, the rate of fall was correlated to the fasting plasma glucose concentration (r = 0.90, p less than 0.01). Thus, the fasting state was not a steady state condition. Using adjusted priming a constant tracer steady state level was obtained within 60 min. In contrast, using fixed priming tracer steady state was not reached within 6 h. The initial tracer level was far below, and increased in time towards the steady state level observed after adjusted priming. Consequently, using Steele's equations after fixed priming, glucose production rates calculated after 90-120 min were overestimated in proportion to fasting hyperglycaemia.
The fasting state in patients with Type 2 diabetes is not a steady state condition. Adjusted priming seems most appropriate in Type 2 diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)
使用预充-连续3-³H-葡萄糖输注法，据报道，在2型（非胰岛素依赖型）糖尿病高血糖患者中，基础葡萄糖生成率比正常水平高140%，或几乎正常。为了确定这些明显不同的结果是否归因于预充模式：固定或调整，或计算模式：稳态或非稳态方程，我们研究了11例2型糖尿病患者（空腹血糖8-20 mmol/l）。先给予40微居里的预充剂量（固定预充）或40微居里·血浆葡萄糖（mmol/l）·5⁻¹（调整预充），然后输注6小时3-³H-葡萄糖（0.40微居里/分钟）。糖尿病患者的血浆葡萄糖浓度并非恒定，而是以0.52±0.07 mmol·l⁻¹·小时⁻¹的速度下降。此外，下降速度与空腹血浆葡萄糖浓度相关（r = 0.90，p<0.01）。因此，空腹状态并非稳态。采用调整预充法，60分钟内可获得恒定的示踪剂稳态水平。相比之下，采用固定预充法，6小时内未达到示踪剂稳态。初始示踪剂水平远低于调整预充后观察到的稳态水平，并随时间向该稳态水平升高。因此，采用固定预充后用斯蒂尔方程计算，90-120分钟后的葡萄糖生成率与空腹高血糖成比例地被高估。
2型糖尿病患者的空腹状态并非稳态。调整预充法似乎最适合2型糖尿病。（摘要截短至250字）
