Koivisto V A, Yki-Järvinen H
Second Department of Medicine, Helsinki University Central Hospital, Finland.
Ann Med. 1990 Jun;22(3):201-5. doi: 10.3109/07853899009147270.
Patients with type 1 diabetes are characterized by an average 40% reduction in the insulin sensitivity. In newly diagnosed patients, insulin resistance is due to insulin deficiency and its metabolic consequences. After the beginning of insulin therapy, insulin sensitivity transiently improves, but deteriorates again after 6-9 months of insulin therapy. Insulin resistance is mainly due to a reduction in glucose uptake by muscle tissue. There are similar relative reductions in both oxidative and nonoxidative glucose disposal. When glucose disposal is determined under similar plasma glucose and insulin concentrations, glucose oxidation, the activity of pyruvate dehydrogenase and glycogen synthase are all reduced. If glucose disposal rate in diabetic patients is normalized by glucose mass action, both oxidative and nonoxidative glucose disposal and glycogen synthase activity become normal. As the normalization of glucose disposal occurs in the face of unchanged muscle glucose-6-phosphate concentrations, this suggest that reduced glucose disposal is secondary to reduced glucose transport in type 1 diabetes.
1型糖尿病患者的特征是胰岛素敏感性平均降低40%。在新诊断的患者中，胰岛素抵抗是由于胰岛素缺乏及其代谢后果所致。开始胰岛素治疗后，胰岛素敏感性会短暂改善，但在胰岛素治疗6 - 9个月后又会再次恶化。胰岛素抵抗主要是由于肌肉组织对葡萄糖的摄取减少。氧化和非氧化葡萄糖处理均有类似程度的相对降低。当在相似的血浆葡萄糖和胰岛素浓度下测定葡萄糖处理时，葡萄糖氧化、丙酮酸脱氢酶和糖原合酶的活性均降低。如果通过葡萄糖质量作用使糖尿病患者的葡萄糖处理率正常化，氧化和非氧化葡萄糖处理以及糖原合酶活性都会恢复正常。由于在肌肉葡萄糖-6-磷酸浓度不变的情况下发生了葡萄糖处理的正常化，这表明1型糖尿病中葡萄糖处理减少是葡萄糖转运减少的继发结果。
