Turner R C, Holman R R
Diabetes. 1978;27 Suppl 1:241-6. doi: 10.2337/diab.27.1.s241.
Maturity-onset diabetic patients usually have raised overnight-fasting plasma glucose levels associated with "normal" basal plasma insulin levels. The basal hyperglycemia is proportional to the degree of insulin deficiency. Basal insulin or C-peptide levels become subnormal if normal fasting plasma glucose levels are attained with insulin. Basal hyperglycemia is probably a compensatory response to maintain near-normal basal insulin levels. A logical therapy of maturity-onset diabetes is to produce basal normoglycemia by means of a constant basal insulin supplement, which can be provided by ultralente insulin. The reduced insulin response of diabetics to intravenous glucose is slightly increased when basal normoglycemia is established, suggesting that the high plasma glucose levels compromise beta cell function. The insulin response to meals in a mild diabetic is not affected by mild hyperglycemia but can be depleted if gross hyperglycemia occurs. Maintenance of normoglycemia then allows beta cell "recovery". In mild diabetics (c. less than 9 mmol per liter basal plasma glucose), chlorpropamide sufficiently stimulates beta cell secretion so that basal normoglycemia can be produced. The C-peptide response to meals is improved, whereas comparable reduction of the plasma glucose with insulin does not alter the meal response. Thus basal normoglycemia can be produced by "resting" beta cells with a basal insulin supplement or by stimulating them with sulfonylurea therapy.
成年型糖尿病患者通常空腹过夜血浆葡萄糖水平升高，同时基础血浆胰岛素水平“正常”。基础高血糖与胰岛素缺乏程度成正比。如果使用胰岛素能使空腹血浆葡萄糖水平恢复正常，基础胰岛素或C肽水平就会低于正常。基础高血糖可能是维持接近正常基础胰岛素水平的一种代偿反应。成年型糖尿病的合理治疗方法是通过持续补充基础胰岛素来实现基础血糖正常，长效胰岛素可提供这种补充。当建立基础血糖正常时，糖尿病患者对静脉注射葡萄糖的胰岛素反应略有增加，这表明高血浆葡萄糖水平会损害β细胞功能。轻度糖尿病患者对进餐的胰岛素反应不受轻度高血糖影响，但如果出现严重高血糖则可能耗尽。维持血糖正常可使β细胞“恢复”。在轻度糖尿病患者（基础血浆葡萄糖约低于9毫摩尔/升）中，氯磺丙脲能充分刺激β细胞分泌，从而产生基础血糖正常。进餐时C肽反应得到改善，而用胰岛素使血浆葡萄糖有类似程度降低时，进餐反应并无改变。因此，通过补充基础胰岛素使β细胞“休息”或用磺脲类药物刺激β细胞，都可产生基础血糖正常。
