Olsson P O, Arnqvist H, von Schenck H
Acta Med Scand. 1986;220(2):133-41. doi: 10.1111/j.0954-6820.1986.tb02741.x.
Twenty-four hour profiles of free insulin and blood glucose were determined in 12 healthy controls and 10 insulin-dependent diabetics treated with insulin regimens based on intermediate-acting insulin injected subcutaneously once or twice a day. The diabetics were ambulatory and in a good glycemic control, i.e. without hyperglycemic symptoms or frequent hypoglycemias and with HbA1 less than 9% (reference value 5.9-7.8%). Body weight was normal and median age (32 years) was the same in both groups. Free insulin was determined after polyethylene glycol precipitation of antibody-bound insulin. The controls had a low basal insulin level (median fasting value 3.9 mU/l) and postprandial peaks with a maximum within 30-60 min. There was no rise in plasma free insulin or blood glucose in the early morning hours. The free insulin profiles in the diabetics were highly unphysiological with hyperinsulinemia between the meals and during the night. The highest plasma free insulin value during the 24 hours was reached before lunch (approximately 5-fold compared to normals, p less than 0.01). Postprandially the free insulin concentrations did not reach the peak levels of the normals. After breakfast, blood glucose rose considerably in the diabetics (p less than 0.02 compared to normals) while the rise after lunch and dinner was not higher than in the healthy controls. The difficulties in glycemic control in the diabetic group, i.e. a blood glucose rise after breakfast and hypoglycemias in some patients, could largely be explained by the unphysiological insulin profiles.
对12名健康对照者和10名接受基于中效胰岛素皮下注射每日1次或2次胰岛素治疗方案的胰岛素依赖型糖尿病患者，测定了24小时游离胰岛素和血糖曲线。这些糖尿病患者可自由活动且血糖控制良好，即无高血糖症状或频繁低血糖发作，糖化血红蛋白低于9%（参考值5.9 - 7.8%）。两组患者体重均正常，中位年龄（32岁）相同。采用聚乙二醇沉淀结合抗体的胰岛素后测定游离胰岛素。健康对照者基础胰岛素水平较低（空腹中位值3.9 mU/l），餐后有峰值，30 - 60分钟内达到最高值。清晨血浆游离胰岛素或血糖无升高。糖尿病患者的游离胰岛素曲线极不符合生理情况，餐间及夜间存在高胰岛素血症。24小时内血浆游离胰岛素最高值在午餐前达到（约为正常人的5倍，p < 0.01）。餐后游离胰岛素浓度未达到正常人的峰值水平。早餐后，糖尿病患者血糖显著升高（与正常人相比p < 0.02），而午餐和晚餐后血糖升高幅度不高于健康对照者。糖尿病组血糖控制困难，即早餐后血糖升高以及部分患者出现低血糖，很大程度上可由不符合生理情况的胰岛素曲线来解释。
