Lutterman J A, Benraad T J, van 't Laar A
Diabetologia. 1981 Aug;21(2):99-102. doi: 10.1007/BF00251274.
The purpose of this study was to investigate whether the great differences in metabolic control between labile and stable insulin dependent juvenile diabetics could be explained by differences in residual pancreatic B cell function. Nine labile diabetics, ten stable diabetics on one insulin injection a day and nine stable diabetics on two insulin injections a day were investigated during a 24-h period during which they maintained their usual diet and insulin therapy. Serum C-peptide concentrations were measured after removal of proinsulin bound to insulin antibodies. The labile diabetics did not show any significant change in C-peptide concentrations despite great fluctuations in plasma glucose concentrations. In six patients with stable diabetes, C-peptide responses after the main meals could be demonstrated and there was a significant correlation between the concentrations of C-peptide and glucose (r = 0.85, p less than 0.001). The other stable patients, having the same mean plasma glucose concentration and mean amplitude of glycaemic excursions, did not show any C-peptide response. It is concluded that persistent insulin secretion is not a prerequisite for metabolic stability. Severe lability, however, seems to occur only in the absence of residual insulin secretion.
本研究的目的是调查不稳定型和稳定型胰岛素依赖型青少年糖尿病患者在代谢控制方面的巨大差异是否可以用残余胰腺B细胞功能的差异来解释。对9名不稳定型糖尿病患者、10名每天注射一次胰岛素的稳定型糖尿病患者和9名每天注射两次胰岛素的稳定型糖尿病患者进行了为期24小时的调查，在此期间他们维持平时的饮食和胰岛素治疗。去除与胰岛素抗体结合的胰岛素原后，测定血清C肽浓度。尽管血糖浓度波动很大，但不稳定型糖尿病患者的C肽浓度没有显示出任何显著变化。在6名稳定型糖尿病患者中，可以证明主餐后的C肽反应，并且C肽浓度与血糖之间存在显著相关性（r = 0.85，p小于0.001）。其他稳定型患者具有相同的平均血糖浓度和血糖波动平均幅度，但没有显示出任何C肽反应。得出的结论是，持续的胰岛素分泌不是代谢稳定的先决条件。然而，严重的不稳定性似乎仅在没有残余胰岛素分泌的情况下发生。
