Leahy J L, Bumbalo L M, Chen C
Division of Endocrinology, Metabolism, and Molecular Medicine, New England Medical Center, Boston, Massachusetts.
Diabetologia. 1993 Dec;36(12):1238-44. doi: 10.1007/BF00400800.
Glucose-induced insulin secretion is impaired in the presence of chronic hyperglycaemia. Insulin secretion was studied in a diabetic rat model prior to the beta cells becoming non-responsive to glucose in order to map out the sequence of changes that accompany chronic hyperglycaemia. In vitro pancreas perfusions were carried out 1 and 2 weeks after a 90% pancreatectomy; controls underwent a sham pancreatectomy. One week post 90% pancreatectomy: (i) non-fasting plasma glucose values were 2-3 mmol/l above normal, (ii) the in vitro insulin response to 16.7 mmol/l glucose was 20 +/- 4% of shams, a response that was appropriate for the surgical reduction in beta-cell mass, (iii) the beta-cell sensitivity for glucose was increased as reflected by left-shifted dose-response curves for glucose-induced insulin secretion (half maximal insulin output 5.7 mmol/l glucose vs 16.5 mmol/l glucose in shams) and glucose potentiation of arginine-induced insulin secretion (half maximal insulin output 3.5 mmol/l glucose vs 14.8 mmol/l glucose in shams). This heightened beta-cell sensitivity for glucose was not a result of the hyperglycaemia, because similarly reduced half-maximal insulin responses were found after a 60% pancreatectomy, a surgical procedure in which plasma glucose values remained normal. In summary, a rise in beta-cell sensitivity for glucose precedes the loss of glucose-induced insulin secretion in diabetic rats.
在慢性高血糖情况下,葡萄糖诱导的胰岛素分泌受损。为了梳理出伴随慢性高血糖的一系列变化,在糖尿病大鼠模型中,于β细胞对葡萄糖变得无反应之前研究了胰岛素分泌情况。在90%胰腺切除术后1周和2周进行体外胰腺灌注;对照组进行假胰腺切除术。90%胰腺切除术后1周:(i)非空腹血浆葡萄糖值比正常高2 - 3 mmol/l,(ii)体外对16.7 mmol/l葡萄糖的胰岛素反应为假手术组的20±4%,该反应与β细胞量手术减少情况相符,(iii)葡萄糖诱导胰岛素分泌的剂量反应曲线左移,以及精氨酸诱导胰岛素分泌的葡萄糖增强作用(假手术组中胰岛素输出量半数最大值时的葡萄糖浓度为14.8 mmol/l,而此处为3.5 mmol/l),反映出β细胞对葡萄糖的敏感性增加。这种对葡萄糖的β细胞敏感性增强并非高血糖所致,因为在60%胰腺切除术后也发现了类似降低的胰岛素反应半数最大值,而该手术过程中血浆葡萄糖值保持正常。总之,在糖尿病大鼠中,β细胞对葡萄糖的敏感性升高先于葡萄糖诱导的胰岛素分泌丧失。