Bratusch-Marrain P R, Komjati M, Waldhäusl W K
Diabetes. 1986 Aug;35(8):922-6. doi: 10.2337/diab.35.8.922.
To evaluate the role of pulsatile insulin administration, hepatic glucose production (HGP) and utilization were studied in type I diabetic patients in the fasting state and during a euglycemic insulin (1 mU X kg-1 X min-1 i.v.) clamp with continuous and pulsatile insulin administration. In the latter study, insulin was infused at twice the continuous rate with 3-min-on/7-min-off intervals, thereby reducing total insulin delivery by 40%. The restraining effect of pulsatile insulin on basal HGP (1.91 +/- 0.35 mg X kg-1 X min-1) was equipotent to continuous insulin exposure (1.80 +/- 0.17 mg X kg-1 X min-1). During the insulin-clamp studies, HGP was equally suppressed by pulsed (0.62 +/- 0.12 mg X kg-1 X min-1) as by continuous insulin infusion (0.63 +/- 0.12 mg X kg-1 X min-1). Insulin-stimulated glucose utilization was not significantly altered in either study (2.55 +/- 0.27 vs. 2.92 +/- 0.23 mg X kg-1 X min-1). When in further studies the total insulin dose given during the pulsatile study was infused continuously (0.6 mU X kg-1 X min-1), HGP in the basal state and residual HGP during the insulin-clamp study were 25-30% higher than in the pulsatile experiments, whereas glucose utilization was not significantly different. In conclusion, by reducing total hormone delivery by up to 40%, but given in a pulsatile fashion, insulin is equally potent in controlling HGP as continuous insulin administration. This greater efficacy of pulsatile exposure in suppressing HGP is accompanied by an equipotent effect on glucose utilization.(ABSTRACT TRUNCATED AT 250 WORDS)
为评估脉冲式胰岛素给药的作用，我们对1型糖尿病患者在空腹状态以及在持续和脉冲式胰岛素给药（静脉注射，1 mU·kg⁻¹·min⁻¹）的正常血糖胰岛素钳夹试验期间的肝葡萄糖生成（HGP）和利用情况进行了研究。在后者的研究中，胰岛素以连续输注速率的两倍进行输注，间隔为3分钟输注/7分钟停用，从而使总胰岛素输注量减少40%。脉冲式胰岛素对基础HGP（1.91±0.35 mg·kg⁻¹·min⁻¹）的抑制作用与持续胰岛素暴露（1.80±0.17 mg·kg⁻¹·min⁻¹）相当。在胰岛素钳夹试验期间，脉冲式（0.62±0.12 mg·kg⁻¹·min⁻¹）和持续胰岛素输注（0.63±0.12 mg·kg⁻¹·min⁻¹）对HGP的抑制作用相同。在两项研究中，胰岛素刺激的葡萄糖利用均无显著改变（2.55±0.27与2.92±0.23 mg·kg⁻¹·min⁻¹）。在进一步的研究中，当将脉冲式研究期间给予的总胰岛素剂量以连续方式输注（0.6 mU·kg⁻¹·min⁻¹）时，基础状态下的HGP以及胰岛素钳夹试验期间的残余HGP比脉冲式实验高25 - 30%，而葡萄糖利用无显著差异。总之，通过将总激素输注量减少多达40%但采用脉冲式给药方式，胰岛素在控制HGP方面与持续胰岛素给药同样有效。脉冲式暴露在抑制HGP方面的这种更高疗效伴随着对葡萄糖利用的等效作用。（摘要截短于250字）
