Czyzyk A, Lao B, Orłowska K, Szczepanik Z, Bartosiewicz W
Pol Arch Med Wewn. 1989 Apr;81(4):193-206.
A group of 15 patients with controlled insulin-independent diabetes (Type 2) were workloaded submaximally by a 15-minute load on a cycle ergometer and 2-3 days later same workload was repeated, but this time 5-patient groups were administered before the workload: 0.1 j.m. of insulin/kg of body mass i.v., 1.0 g tolbutamide sodium i.v. and 150 mg of phenformin orally one hour before the load. The patients who were injected insulin or tolbutamide were also administered glucose solution (intravenously) so as to keep the same level of glycaemia as in the follow-up examination. The time of metabolic observation after workload was 90 min., so the whole examination took 105 minutes. In the first (follow-up) examination, all the probands had in the venous blood an increase in alanine, lactate, pyruvate and the relation lactate: pyruvate (L/P), a decrease in pH, bicarbonates and pO2 (in capillary afterialized blood). The administration of insulin and tolbutamide eliminated or reduced after-effort alaninaemia increase, whereas the administration of phenformin increased the concentration of this amino acid in the blood after effort. Insulin resulted in a greater increase in after-effort lactacidaemia; besides, insulin and tolbutamide increased the relation L/P during and after effort. The influence of antidiabetic drugs on the behaviour of other biochemical parameters after effort was insignificant. The results obtained show that antidiabetic drugs modify the increase in alaninaemia after effort in patients with controlled insulin-independent diabetes (Type 2), the direction of the modification depending on a specific influence of particular drugs on the metabolism of this amino acid. While evaluating the influence of effort on the concentration of alanine in the blood in patients with this type of diabetes one should consider not only the present demand for this gluconeogenes substrate but also a specific influence of the kind of therapy applied at the time.
一组15名胰岛素非依赖型（2型）糖尿病病情得到控制的患者，在自行车测力计上进行15分钟的次最大负荷运动，2至3天后重复相同负荷，但这次在负荷前将患者分成5人一组，并分别给予：每千克体重0.1单位胰岛素静脉注射、1.0克甲苯磺丁脲钠静脉注射以及在负荷前1小时口服150毫克苯乙双胍。注射胰岛素或甲苯磺丁脲的患者还静脉输注葡萄糖溶液，以使血糖水平保持在与后续检查相同的水平。负荷后代谢观察时间为90分钟，因此整个检查耗时105分钟。在首次（后续）检查中，所有受试者静脉血中的丙氨酸、乳酸、丙酮酸以及乳酸与丙酮酸的比值（L/P）均升高，pH值、碳酸氢盐和pO2（毛细血管化后的静脉血）降低。胰岛素和甲苯磺丁脲的给药消除或减轻了运动后丙氨酸血症的升高，而苯乙双胍的给药则增加了运动后血液中该氨基酸的浓度。胰岛素导致运动后乳酸血症有更大程度的升高；此外，胰岛素和甲苯磺丁脲在运动期间和运动后增加了L/P比值。抗糖尿病药物对运动后其他生化参数行为的影响不显著。所得结果表明，抗糖尿病药物可改变胰岛素非依赖型（2型）糖尿病病情得到控制的患者运动后丙氨酸血症的升高情况，这种改变的方向取决于特定药物对该氨基酸代谢的具体影响。在评估此类糖尿病患者运动对血液中丙氨酸浓度的影响时，不仅应考虑当前对这种糖异生底物的需求，还应考虑当时所应用治疗方法的特定影响。
