Kollind M, Adamson U, Lins P E
Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden.
Acta Med Scand. 1988;223(2):153-7. doi: 10.1111/j.0954-6820.1988.tb15780.x.
Insulin resistance was assessed after a hypoglycemia induced by insulin (1.5 mU X kg-1 X min-1) between 7 and 8 a.m. in 10 well-insulinized patients with insulin-dependent diabetes mellitus (IDDM). Blood glucose levels during a somatostatin (100 micrograms X h-1)-insulin (0.4 mU X kg-1 X min-1)-glucose (4.5 mg X kg-1)-infusion test (SIGIT) performed between 11 a.m. and 3 p.m. served as an indicator of total body insulin resistance. Plasma epinephrine, growth hormone, and cortisol increased in response to hypoglycemia, while blunted responses of glucagon were simultaneously registered. At the start of the subsequent SIGIT, blood glucose and plasma-free insulin concentrations were similar to those obtained in the control study without preceding hypoglycemia, and at this point all counter-regulatory hormones had returned to basal. During the SIGIT close to identical levels of plasma-free insulin and counter-regulatory hormones were registered, despite which a significant hyperglycemia was seen 2 hours after the start of the SIGIT when preceded by hypoglycemia. In a separate study, the SIGIT was shown to have a good reproducibility in IDDM patients. We conclude that hypoglycemia evokes a state of insulin resistance for several hours, as demonstrated by elevated blood glucose levels during a somatostatin-insulin-glucose-infusion test.
在上午7点至8点之间，对10例胰岛素依赖型糖尿病（IDDM）且胰岛素治疗良好的患者，用胰岛素（1.5 mU·kg⁻¹·min⁻¹）诱发低血糖后评估胰岛素抵抗。在上午11点至下午3点进行的生长抑素（100微克·小时⁻¹）-胰岛素（0.4 mU·kg⁻¹·min⁻¹）-葡萄糖（4.5毫克·kg⁻¹）输注试验（SIGIT）期间的血糖水平作为全身胰岛素抵抗的指标。低血糖反应时血浆肾上腺素、生长激素和皮质醇升高，同时观察到胰高血糖素反应迟钝。在随后的SIGIT开始时，血糖和血浆游离胰岛素浓度与未进行低血糖预处理的对照研究中获得的浓度相似，此时所有反调节激素均恢复至基础水平。在SIGIT期间，尽管血浆游离胰岛素和反调节激素水平接近相同，但在低血糖预处理后的SIGIT开始2小时后出现了明显的高血糖。在另一项研究中，SIGIT在IDDM患者中显示出良好的可重复性。我们得出结论，低血糖会诱发数小时的胰岛素抵抗状态，这在生长抑素-胰岛素-葡萄糖输注试验期间血糖水平升高得到了证实。
