Bloch C A, Clemons P, Sperling M A
J Pediatr. 1987 Mar;110(3):481-7. doi: 10.1016/s0022-3476(87)80522-x.
Puberty is commonly associated with an increase in insulin requirement in patients with insulin-dependent diabetes. To investigate whether this pubertal increase in insulin requirement is confined to diabetic subjects, we examined insulin responses during oral glucose tolerance testing with glucose loads per unit weight (1.75 g/kg) or unit surface area (55 g/m2), and insulin sensitivity via euglycemic-hyperinsulinemic clamp in prepubertal and pubertal children without diabetes. Irrespective of glucose dose, glucose tolerance testing elicited a threefold greater insulin response, but equivalent euglycemia, in pubertal versus prepubertal children (P less than 0.05). As assessed by the clamp procedure, prepubertal children were approximately 30% more sensitive than their pubertal counterparts (P less than 0.01). Insulin sensitivity correlated inversely with body mass index (r = -0.49, P less than 0.02), serum dehydroepiandrosterone sulphate concentration (r = -0.57, P less than 0.01), and log somatomedin C/insulinlike growth factor I (r = -0.45, P less than 0.05). We conclude that puberty is associated with decreased sensitivity to insulin that normally is compensated for by increased insulin secretion. Thus, in patients with insulin-dependent diabetes, an approximately 30% increase in insulin dosage should be anticipated with the onset of puberty.
青春期通常与胰岛素依赖型糖尿病患者胰岛素需求量增加有关。为了研究这种青春期胰岛素需求量的增加是否仅限于糖尿病患者，我们在口服葡萄糖耐量试验中，以每单位体重（1.75克/千克）或单位体表面积（55克/平方米）的葡萄糖负荷，对青春期前和青春期无糖尿病儿童的胰岛素反应进行了检测，并通过正常血糖-高胰岛素钳夹技术评估了胰岛素敏感性。无论葡萄糖剂量如何，葡萄糖耐量试验在青春期儿童中引发的胰岛素反应比青春期前儿童大两倍，但血糖水平相当（P<0.05）。通过钳夹程序评估，青春期前儿童比青春期儿童的胰岛素敏感性高约30%（P<0.01）。胰岛素敏感性与体重指数（r = -0.49，P<0.02）、血清硫酸脱氢表雄酮浓度（r = -0.57，P<0.01）以及对数生长介素C/胰岛素样生长因子I（r = -0.45，P<0.05）呈负相关。我们得出结论，青春期与胰岛素敏感性降低有关，而胰岛素敏感性降低通常会通过增加胰岛素分泌来代偿。因此，对于胰岛素依赖型糖尿病患者，随着青春期的到来，预计胰岛素剂量应增加约30%。
