Brown P M, Tompkins C V, Juul S, Sönksen P H
Br Med J. 1978 May 13;1(6122):1239-42. doi: 10.1136/bmj.1.6122.1239.
Six insulin-requiring diabetics were studied after insulin had been withheld for 24 hours. On three separate occasions each received a two-hour infusion of insulin at a low dose (2.6 U/h) and a high dose (10.6 U/h) and an infusion of saline as control. The rates of production and utilisation of glucose were measured isotopically. The rate of fall of plasma glucose concentration was faster on the high-dose infusion of insulin than on the low, whereas the fall in plasma free fatty acids, glycerol, and keton bodies was the same on both insulin infusions. The mechanism whereby the two rates of insulin administration lowered plasma glucose concentration differed: during the low-dose infusion the decrease in the glucose concentration was produced entirely by a fall of hepatic glucose output, whereas during the high-dose insulin infusion the glucose concentration fell because both the rate of glucose production fell and the rate of glucose utilisation rose. In all experiments there was a direct relation between a fall in serum potassium concentration and the fall in plasma glucose concentration irrespective of the mechanism that reduced the glucose concentration.These results indicate that in uncontrolled diabetics low-dose insulin infusions lower the blood glucose concentration entirely by reducing glucose production from the liver and that the effect of insulin on potassium transport is independent of its effect on glucose uptake.
对6名需要胰岛素治疗的糖尿病患者进行了研究，在停用胰岛素24小时后，每位患者在三个不同时间分别接受了两小时的低剂量（2.6单位/小时）和高剂量（10.6单位/小时）胰岛素输注以及作为对照的生理盐水输注。采用同位素法测定葡萄糖的生成和利用速率。高剂量胰岛素输注时血浆葡萄糖浓度的下降速度比低剂量时更快，而两种胰岛素输注时血浆游离脂肪酸、甘油和酮体的下降情况相同。两种胰岛素输注速率降低血浆葡萄糖浓度的机制不同：低剂量输注期间，葡萄糖浓度的降低完全是由于肝葡萄糖输出量下降所致，而高剂量胰岛素输注期间，葡萄糖浓度下降是因为葡萄糖生成速率下降和葡萄糖利用速率上升。在所有实验中，无论降低葡萄糖浓度的机制如何，血清钾浓度的下降与血浆葡萄糖浓度的下降之间都存在直接关系。这些结果表明，在未控制的糖尿病患者中，低剂量胰岛素输注完全通过减少肝脏葡萄糖生成来降低血糖浓度，并且胰岛素对钾转运的作用与其对葡萄糖摄取的作用无关。
