Koivisto V A, Yki-Järvinen H, Helve E, Karonen S L, Pelkonen R
Diabetes. 1986 Jan;35(1):78-82. doi: 10.2337/diab.35.1.78.
The mechanism of the dawn phenomenon was studied in 12 C-peptide-negative type I diabetic patients (age 30 +/- 2 yr) treated with continuous subcutaneous insulin infusion. During constant basal infusion, nocturnal glycemia remained constant until 4 a.m., but began to rise thereafter in 10/12 patients, with the mean rise from 4.6 +/- 0.4 mmol/L to 6.1 +/- 0.7 mmol/L (P less than 0.01) by 8 a.m. In these patients the rate of glucose production (Ra, 2.14 +/- 0.04 mg/kg/min, 3-H3-glucose infusion) exceeded the rate of utilization (Rd, 1.89 +/- 0.03 mg/kg/min, P less than 0.02). When the patients were restudied after the infusion rate was increased by 49 +/- 7%, Ra fell to 1.75 +/- 0.03 mg/kg/min (P less than 0.01) and the dawn phenomenon was abolished. However, both Ra and Rd remained higher in the diabetic subjects (P less than 0.05) than in eight healthy control subjects, in whom Ra (1.66 +/- 0.02 mg/kg/min) was equal to Rd with glycemia remaining unchanged. Peripheral free insulin levels in the diabetic patients were similar during constant (12.3 +/- 0.5 mU/L) and increased infusion rate (11.3 +/- 0.4 mU/L), and higher than those of the control subjects (5.2 +/- 0.2 mU/L, P less than 0.05). A diurnal rise in serum cortisol levels occurred 1 h earlier in the diabetic than in the control subjects, and Ra was directly proportional to serum cortisol concentration (r = 0.61, P less than 0.01). Serum growth hormone levels were also slightly higher in the diabetic than the control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
对12名接受持续皮下胰岛素输注治疗的C肽阴性I型糖尿病患者（年龄30±2岁）的黎明现象机制进行了研究。在持续基础输注期间，夜间血糖在凌晨4点前保持恒定，但此后12名患者中有10名开始升高，到上午8点时平均从4.6±0.4 mmol/L升至6.1±0.7 mmol/L（P<0.01）。在这些患者中，葡萄糖生成率（Ra，2.14±0.04 mg/kg/min，3-H3-葡萄糖输注）超过利用率（Rd，1.89±0.03 mg/kg/min，P<0.02）。当输注速率提高49±7%后对患者再次进行研究时，Ra降至1.75±0.03 mg/kg/min（P<0.01），黎明现象消失。然而，糖尿病患者的Ra和Rd仍高于8名健康对照者（P<0.05），在健康对照者中，Ra（1.66±0.02 mg/kg/min）与Rd相等，血糖保持不变。糖尿病患者在持续输注（12.3±0.5 mU/L）和输注速率增加时（11.3±0.4 mU/L）外周游离胰岛素水平相似，且高于对照者（5.2±0.2 mU/L，P<0.05）。糖尿病患者血清皮质醇水平的昼夜升高比对照者早1小时出现，且Ra与血清皮质醇浓度成正比（r = 0.61，P<0.01）。糖尿病患者的血清生长激素水平也略高于对照者。（摘要截短于250字）
