Vague P, Ramahandridona G, Vialettes B, Raymond J P, Vague J
Diabete Metab. 1978 Dec;4(4):261-5.
The acute insulin responses to intravenous glucose and tolbutamide were studied serially in middle aged subjects with a wide spectrum of glucose tolerance. Eighty were of normal weight, 102 frankly obese. In normal weight patients, insulin response to glucose, subnormal in chemical diabetes, was almost absent when fasting blood glucose was elevated. Tolbutamide evoked a normal response provided that the fasting blood glucose was lower than 125 mg/100 ml. The response decreased dramatically thereafter. In the obese the response decreased dramatically thereafter. In the obese the response to glucose was decreased in chemical diabetics compared to non-diabetics, but failed completely only when the fasting glycemia exceeded 200 mg/100 ml. The response to tolbutamide decreased only with fasting glycemia in excess of 200 mg/100 ml. When insulin responses were expressed relative to basal insulin values the differences between non diabetic obese and normal weight subjects disappeared but this was not true of the other categories. These findings demonstrate that the B-cell responses differ not only quantitatively but also in kind between normal weight and obese diabetics. Six cases of incipient juvenile diabetes (100 less than fasting blood glucose less than 125 mg/100 ml) showed no insulin response to glucose nor to tolbutamide in contrast to the comparable weight group of maturity onset diabetics.
对糖耐量范围广泛的中年受试者，连续研究了其对静脉注射葡萄糖和甲苯磺丁脲的急性胰岛素反应。80人体重正常，102人明显肥胖。在体重正常的患者中，化学性糖尿病患者对葡萄糖的胰岛素反应在空腹血糖升高时几乎消失。如果空腹血糖低于125mg/100ml，甲苯磺丁脲可引起正常反应。此后反应急剧下降。在肥胖者中，此后反应也急剧下降。在肥胖者中，与非糖尿病患者相比，化学性糖尿病患者对葡萄糖的反应降低，但仅在空腹血糖超过200mg/100ml时才完全消失。对甲苯磺丁脲的反应仅在空腹血糖超过200mg/100ml时才降低。当胰岛素反应相对于基础胰岛素值表示时，非糖尿病肥胖者和体重正常者之间的差异消失，但其他类别并非如此。这些发现表明，体重正常的糖尿病患者和肥胖的糖尿病患者之间，B细胞反应不仅在数量上不同，而且在性质上也不同。6例早期青少年糖尿病患者（空腹血糖100＜空腹血糖＜125mg/100ml）对葡萄糖和甲苯磺丁脲均无胰岛素反应，这与同龄组的成年发病糖尿病患者形成对比。
