Lager I, Lönnroth P, von Schenck H, Smith U
Br Med J (Clin Res Ed). 1983 Dec 3;287(6406):1661-4. doi: 10.1136/bmj.287.6406.1661.
Insulin responsiveness was studied with the euglycaemic glucose clamp technique in seven patients with type I diabetes and in six control subjects matched for age and weight. The glucose disposal rate was significantly reduced in the diabetic subjects when they were receiving conventional insulin treatment compared with the control group, showing insulin resistance in the diabetics. The diabetic patients were again studied after eight days of intensified metabolic control achieved with continuous subcutaneous insulin infusion. During the infusion a more physiological insulin regimen was used compared with their regular treatment, less of the total insulin dose being given as continuous infusion and more as bolus doses before meals. The insulin resistance in the diabetics was largely reversed after this improved metabolic control. Dose response studies showed an increased glucose disposal rate at all plasma insulin concentrations, including the maximum insulin concentration, indicating a predominant effect of the continuous infusion regimen at the postreceptor level. The improved insulin effect seen with continuous subcutaneous insulin infusion could be due to the improved metabolic control achieved as well as the more physiological regimen.
采用正常血糖葡萄糖钳夹技术，对7例1型糖尿病患者和6例年龄、体重匹配的对照者的胰岛素反应性进行了研究。与对照组相比，糖尿病患者接受传统胰岛素治疗时，葡萄糖处置率显著降低，表明糖尿病患者存在胰岛素抵抗。在通过持续皮下胰岛素输注实现强化代谢控制8天后，再次对糖尿病患者进行研究。在输注期间，与常规治疗相比，采用了更符合生理的胰岛素治疗方案，即总胰岛素剂量中较少部分作为持续输注，较多部分作为餐前大剂量给药。在这种改善的代谢控制后，糖尿病患者的胰岛素抵抗在很大程度上得到了逆转。剂量反应研究表明，在所有血浆胰岛素浓度（包括最大胰岛素浓度）下，葡萄糖处置率均增加，表明持续输注方案在受体后水平具有主要作用。持续皮下胰岛素输注所见的胰岛素作用改善可能归因于所实现的代谢控制改善以及更符合生理的治疗方案。
