Press M, Tamborlane W V, Sherwin R S
N Engl J Med. 1984 Mar 29;310(13):810-5. doi: 10.1056/NEJM198403293101302.
To evaluate the importance of the raised levels of growth hormone that characterize poor diabetic control, we gave growth hormone for 21 to 45 hours in the form of hourly 100-micrograms pulses to 14 diabetics being treated by insulin pump. Insulin-pump settings and meals were kept constant. Mean 24-hour levels of growth hormone (+/- S.E.M.) rose from 8 +/- 1 to 16 +/- 2 ng per milliliter--values identical to those observed in 12 other patients with poorly controlled diabetes (17 +/- 3 ng per milliliter). Plasma glucose concentrations doubled within 8 to 10 hours and remained elevated until growth hormone was discontinued (fasting glucose level rose from 86 +/- 11 to 204 +/- 17 mg per deciliter at 18 hours and to 240 +/- 20 mg per deciliter at 42 hours). The hyperglycemia was due mainly to a marked stimulation of hepatic glucose production that occurred without changes in levels of free insulin or glucagon. Levels of circulating free fatty acids, ketones, and branched-chain amino acids were also increased. The moderate elevations in growth hormone levels that occur in poorly controlled diabetes can themselves reproduce the whole spectrum of abnormal metabolic fuel concentrations that are associated with poor diabetic control, despite optimized insulin treatment. Thus, hypersecretion of growth hormone may be the cause as much as the consequence of poor diabetic control.
为评估生长激素水平升高在糖尿病控制不佳中的重要性，我们以每小时100微克脉冲的形式，给14名接受胰岛素泵治疗的糖尿病患者注射生长激素21至45小时。胰岛素泵设置和饮食保持不变。生长激素的平均24小时水平（±标准误）从每毫升8±1纳克升至16±2纳克，这与其他12名糖尿病控制不佳患者（每毫升17±3纳克）的观察值相同。血浆葡萄糖浓度在8至10小时内翻倍，并一直保持升高，直到停止注射生长激素（空腹血糖水平在18小时时从每分升86±11毫克升至204±17毫克，在42小时时升至240±20毫克）。高血糖主要是由于肝脏葡萄糖生成显著增加，而游离胰岛素或胰高血糖素水平并无变化。循环游离脂肪酸、酮体和支链氨基酸水平也升高。尽管进行了优化胰岛素治疗，但糖尿病控制不佳时出现的生长激素水平适度升高本身就可重现与糖尿病控制不佳相关的整个异常代谢燃料浓度谱。因此，生长激素分泌过多可能既是糖尿病控制不佳的原因，也是其结果。
