Permutt M A, Keller D, Santiago J
Diabetes. 1977 Feb;26(2):121-7. doi: 10.2337/diab.26.2.121.
The effects of cholinergic blockade on the plasma glucose and insulin responses during oral and intravenous glucose administration were studied. Propantheline (30 mg.) was given by mouth 45 minutes before standard glucose tolerance testing to produce symptomatic chollinergic blockade. In 10 normal subjects a flattening of the over-all plasma glucose response to oral glucose was observed compared with the control test, whereas insulin secretion was not different. In seven patients with repeated episodes of symptomatic reactive hypoglycemia, cholinergic blockade eliminated both symptomatic and chemical hypoglycemia in each, raising the mean nadir glucose from 44 +/- 4 mg./dl. to 84 +/- 8 mg./dl. (p less than 0.01) and significantly reducing insulin secretion. In contrast, following intravenous glucose challenge, cholinergic blockade produced no significant difference in the rate of glucose utilization or insulin secretion in either group. These results are compatible with the hypothesis that excessive vagal stimulation may contribute to the hypoglycemia seen in patients with reactive hypoglycemia but suggest that the predominant effect is on the gastrointestinal tract rather than on pancreatic islets directly. These studies confirm that anticholinergic drugs may be useful adjuvants in treating these patients.
研究了胆碱能阻滞对口服和静脉注射葡萄糖期间血浆葡萄糖和胰岛素反应的影响。在标准葡萄糖耐量试验前45分钟口服丙胺太林（30毫克）以产生有症状的胆碱能阻滞。与对照试验相比，在10名正常受试者中观察到口服葡萄糖后总体血浆葡萄糖反应变平，而胰岛素分泌无差异。在7例反复出现有症状性反应性低血糖发作的患者中，胆碱能阻滞消除了每位患者的症状性和化学性低血糖，使平均最低血糖从44±4毫克/分升升至84±8毫克/分升（p＜0.01），并显著降低胰岛素分泌。相比之下，静脉注射葡萄糖激发后，胆碱能阻滞在两组中对葡萄糖利用率或胰岛素分泌率均未产生显著差异。这些结果与以下假设相符，即迷走神经刺激过度可能导致反应性低血糖患者出现低血糖，但表明主要作用是在胃肠道而非直接作用于胰岛。这些研究证实抗胆碱能药物可能是治疗这些患者的有用辅助药物。
