Reynolds C, Molnar G D, Horwitz D L, Rubenstein A H, Taylor W F, Jiang N S
Diabetes. 1977 Jan;26(1):36-45. doi: 10.2337/diab.26.1.36.
The responses of glucagon, growth hormone, and insulin secretion to the oral administration of glucose and to the intravenous infusion of saline, arginine, and insulin were measured in seven patients who had stable diabetes, eight who had unstable diabetes, and seven healthy volunteers. Hyperglycemia suppressed secretion of glucagon in normal subjects but not in diabetics. The oral glucose and arginine infusion tests demonstrated partial preservation of insulin-secretory ability in stable diabetics and its virxual absence in unstable diabetics. Glucagon responses to arginine infusion were similar in all three groups. In response to hypoglycemia induced by insulin infusion, the concentrations of plasma glucagon increased in normal subjects and, to a lesser extent, in stable diabetics but increased in only two of the unstable diabetics. The impairment in glucagon response during hypoglycemia in diabetics correlated positively with the degree of diabetic instability and insulin deficiency during glucose and arginine testing. The severity of the insulin deficiency also correlated with the degree of diabetic instability. These findings support the hypothesis that inherent abnormalities of insulin and glucagon secretion may account for many of the clinical characteristics of unstable and stable diabetic patients.
对7例病情稳定的糖尿病患者、8例病情不稳定的糖尿病患者和7名健康志愿者，测量了胰高血糖素、生长激素及胰岛素分泌对口服葡萄糖以及静脉输注生理盐水、精氨酸和胰岛素的反应。高血糖抑制正常受试者的胰高血糖素分泌，但对糖尿病患者无此作用。口服葡萄糖和精氨酸输注试验表明，病情稳定的糖尿病患者胰岛素分泌能力部分保留，而病情不稳定的糖尿病患者几乎没有胰岛素分泌能力。三组对精氨酸输注的胰高血糖素反应相似。静脉输注胰岛素诱导低血糖时，正常受试者血浆胰高血糖素浓度升高，病情稳定的糖尿病患者升高程度较小，而病情不稳定的糖尿病患者只有2例升高。糖尿病患者低血糖时胰高血糖素反应受损与糖尿病不稳定程度以及葡萄糖和精氨酸检测时的胰岛素缺乏程度呈正相关。胰岛素缺乏的严重程度也与糖尿病不稳定程度相关。这些发现支持这样的假说，即胰岛素和胰高血糖素分泌的内在异常可能是病情不稳定和稳定的糖尿病患者许多临床特征的原因。
