糖尿病患者血糖反向调节功能缺陷是自主神经病变的一种选择性形式。
Defective blood glucose counter-regulation in diabetics is a selective form of autonomic neuropathy.
作者信息
Campbell L V, Kraegen E W, Lazarus L
出版信息
Br Med J. 1977 Dec 10;2(6101):1527-9. doi: 10.1136/bmj.2.6101.1527.
Abstract
Administration of a low-dose insulin infusion to normal subjects results in a mild drop in blood glucose concentration (1.1 mmol/1 (20 mg/100 ml)) and the resetting of the basal glucose at the lower concentration. Clinical hypoglycaemia does not develop, and there is a significant release of glucagon, growth hormone, and cortisol. A similar infusion in insulin-requiring diabetics results in hypoglycaemia accompanied by a release of growth hormone and cortisol but no significant release of glucagon. Subsequently giving arginine to these patients results in a significant release of glucagon, indicating that the alpha cell is intact and can respond to local, direct stimulation. In one patient the defect in glucagon response to impending hypoglycaemia developed after two years' insulin treatment. This type of dissociated response' of the alpha cell has been reported in animals after denervation of the pancreas, and insulin-requiring diabetics may develop a selective form of autonomic neuropathy affecting the vagal control of glucagon release.
摘要
对正常受试者输注小剂量胰岛素会导致血糖浓度轻度下降（1.1 mmol/L（20 mg/100 ml）），并使基础血糖在较低浓度下重新设定。不会发生临床低血糖，且会有胰高血糖素、生长激素和皮质醇的显著释放。对需要胰岛素治疗的糖尿病患者进行类似的输注会导致低血糖，同时伴有生长激素和皮质醇的释放，但胰高血糖素无显著释放。随后给这些患者输注精氨酸会导致胰高血糖素显著释放，表明α细胞完好无损且能对局部直接刺激作出反应。在一名患者中，胰高血糖素对即将发生的低血糖的反应缺陷在胰岛素治疗两年后出现。胰腺去神经支配后的动物中曾报道过这种α细胞的“分离反应”，需要胰岛素治疗的糖尿病患者可能会出现一种选择性自主神经病变，影响迷走神经对胰高血糖素释放的控制。
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