Saibene V, Alberetto M, Dossi G, Andreoni B, Cordaro C, Vegeto G, Dabandi M
Acta Diabetol Lat. 1981 Apr-Jun;18(2):183-90. doi: 10.1007/BF02099004.
Four euglycemic glucose-clamp studies by artificial pancreas (Biostator, Miles) have been performed during prolonged fast before and after pharmacological treatment in a patient with insulinoma. In the basal state a high glucose infusion rate (8.9 g/h) was unable to achieve the preselected blood glucose plateau of 80 mg/100 ml. The plasma insulin levels during this first glucose-clamp were comprised between 18 and 50 microunits/ml. On the first day of diazoxide treatment (300 mg/die),. the glucose infusion rate decreased to 6.4 g/h, without variation in plasma insulin level, thus suggesting a diazoxide effect independent of the inhibition of insulin secretion. After 7 days of diazoxide treatment, a further reduction of glucose infusion (5.8 g/h), together with a lowering of plasma insulin levels (7-18 microunits/ml) was observed. Both in the basal state and during diazoxide treatment a circadian pattern of glucose requirement was noted, with lower glucose need and plasma insulin levels during the night. Surgery was undertaken with glucose-clamp by artificial pancreas; blood glucose level being higher than the preselected value of 80 mg/100 ml, simple monitoring of glycemia was performed. The excision of a single adenoma was followed by a substantial rise in blood glucose 20 min later. An additional glucose-clamp, performed 3 months after surgery showed a dramatic fall of the glucose infusion rate (2.9 g/h) needed to achieve the preselected blood glucose plateau, confirming the completeness of the intervention. This experience shows that glucose-clamp by artificial pancreas may be of great value in the study as well as in the pharmacological and surgical treatment of patients with insulinoma.
在一名胰岛素瘤患者长时间禁食期间及药物治疗前后，使用人工胰腺（Biostator，迈尔斯公司）进行了四项正常血糖钳夹研究。在基础状态下，高葡萄糖输注速率（8.9克/小时）无法达到预先选定的80毫克/100毫升血糖平台。第一次血糖钳夹期间血浆胰岛素水平在18至50微单位/毫升之间。在二氮嗪治疗的第一天（300毫克/天），葡萄糖输注速率降至6.4克/小时，血浆胰岛素水平无变化，因此提示二氮嗪的作用独立于对胰岛素分泌的抑制。二氮嗪治疗7天后，观察到葡萄糖输注进一步减少（5.8克/小时），同时血浆胰岛素水平降低（7 - 18微单位/毫升）。在基础状态和二氮嗪治疗期间均注意到葡萄糖需求的昼夜模式，夜间葡萄糖需求和血浆胰岛素水平较低。使用人工胰腺进行血糖钳夹下进行手术；由于血糖水平高于预先选定的80毫克/100毫升值，因此进行了简单的血糖监测。切除单个腺瘤后20分钟血糖大幅升高。术后3个月进行的另一次血糖钳夹显示，达到预先选定血糖平台所需的葡萄糖输注速率急剧下降（2.9克/小时），证实了干预的完整性。该经验表明，人工胰腺血糖钳夹在胰岛素瘤患者的研究以及药理和手术治疗中可能具有重要价值。
