Beylot M, Khalfallah Y, Laville M, Sautot G, Dechaud H, Serusclat P, Berthezene F, Riou J P, Mornex R
INSERM U. 197. Faculté de Médecine Alexis-Carrel, Lyon, France.
Diabete Metab. 1987 Jul-Aug;13(4):450-6.
In order to determine if intraperitoneal insulin infusion could improve the insulin resistance of type 1 diabetic patients we have used the englycaemic insulin clamp technique in order to study the effects of insulin on glucose disposal in four C peptide negative type 1 diabetic patients treated by continuous subcutaneous or intraperitoneal insulin infusion and in five control subjects. Compared to control subjects, the diabetic patients treated by subcutaneous insulin infusion had a decreased maximal capacity of glucose utilization (diabetics: 12.6 +/- 0.3 mg.kg-1.min-1; controls: 15.7 +/- 0.7 mg/kg-1.min-1, p less than 0.01) and a trend towards higher half-maximally effective insulin concentrations (diabetics: 70 +/- 11 mU/l-1, controls: 48 +/- 4 mU/l-1). Treatment of the diabetic patients by intraperitoneal insulin infusion for 2 months decreased their mean peripheral free insulin levels (during subcutaneous infusion: 23.5 +/- 2.2 mU/l-1; during intraperitoneal infusion: 18.4 +/- 1.4 mU/l-1, p less than 0.05). However, mean daily insulin requirements were not decreased (during subcutaneous infusion: 0.59 +/- 0.05 U/kg-1.day-1; during intraperitoneal infusion: 0.57 +/- 0.03 U/kg-1.min-1). Moreover, the diabetic patients had a consistently lower maximal capacity of glucose utilization (12.6 +/- 0.7 mg kg-1.min-1) than control subjects (p less than 0.01) without modification of the half-maximally effective insulin concentration (62 +/- 10 mU.l-1). In conclusion, the only benefit of intraperitoneal insulin infusion was a reduction of peripheral free insulin levels; this decrease of peripheral insulinaemia was not associated with an improvement in the insulin resistance of diabetic patients.
为了确定腹腔内输注胰岛素是否能改善1型糖尿病患者的胰岛素抵抗，我们采用了血糖胰岛素钳夹技术，以研究胰岛素对4例接受持续皮下或腹腔内胰岛素输注治疗的C肽阴性1型糖尿病患者以及5例对照者葡萄糖代谢的影响。与对照者相比，接受皮下胰岛素输注治疗的糖尿病患者葡萄糖利用的最大能力降低（糖尿病患者：12.6±0.3mg·kg⁻¹·min⁻¹；对照者：15.7±0.7mg/kg⁻¹·min⁻¹，p<0.01），且半数最大效应胰岛素浓度有升高趋势（糖尿病患者：70±11mU/l⁻¹，对照者：48±4mU/l⁻¹）。对糖尿病患者进行2个月的腹腔内胰岛素输注治疗降低了他们外周游离胰岛素的平均水平（皮下输注期间：23.5±2.2mU/l⁻¹；腹腔内输注期间：18.4±1.4mU/l⁻¹，p<0.05）。然而，每日胰岛素平均需求量并未降低（皮下输注期间：0.59±0.05U/kg⁻¹·day⁻¹；腹腔内输注期间：0.57±0.03U/kg⁻¹·min⁻¹）。此外，糖尿病患者的葡萄糖利用最大能力始终低于对照者（12.6±0.7mg kg⁻¹·min⁻¹）（p<0.01），而半数最大效应胰岛素浓度未改变（62±10mU.l⁻¹）。总之，腹腔内胰岛素输注的唯一益处是外周游离胰岛素水平降低；外周胰岛素血症的这种降低与糖尿病患者胰岛素抵抗的改善无关。
