Fowelin J, Attvall S, von Schenck H, Bengtsson B A, Smith U, Lager I
Department of Medicine II, University of Göteborg, Sahlgren's Hospital, Sweden.
Metabolism. 1993 Mar;42(3):387-94. doi: 10.1016/0026-0495(93)90092-3.
The aim of the present study was to characterize the effect of a hyperglycemic period (44 hours) on the levels of insulin-antagonistic hormones and insulin sensitivity in seven subjects with well-controlled insulin-dependent diabetes mellitus (IDDM). Hyperglycemia (approximately 15 mmol.L-1) was induced by a glucose infusion while the degree of insulinization was similar to that of the period with near normoglycemia (approximately 6.9 mmol.L-1). Insulin sensitivity was measured with hyperinsulinemic euglycemic clamps performed 4 hours before and after the periods of normoglycemia (control) and hyperglycemia. D-[3-3H]glucose was infused in the second clamp in each study to evaluate glucose production and utilization. Since growth hormone (GH) levels frequently are elevated during poor diabetic control, diurnal GH secretion was measured in blood samples continuously drawn for 24 hours during the euglycemic and hyperglycemic periods. Levels of epinephrine, norepinephrine, cortisol, and nonesterified free fatty acids (NEFA) were similar during the control and hyperglycemic periods and during the clamps. GH levels were also similar, but an abnormal diurnal secretion pattern was present with increased numbers of daytime peaks. Hyperglycemia did not reduce GH secretion in IDDM. Hyperglycemia for 44 hours induced insulin resistance (32% reduction of glucose infusion rate, P < .02). In the control study, a 21% reduction (P = .064, NS) of the glucose disposal rate (Rd) was seen, suggesting that the hospitalization period per se may also reduce insulin sensitivity. In conclusion, a period of hyperglycemia leads to insulin resistance in IDDM patients. This insulin resistance cannot be attributable to increased levels of insulin-antagonistic hormones, although an abnormal secretion pattern for GH was found.(ABSTRACT TRUNCATED AT 250 WORDS)
本研究的目的是，在7名胰岛素依赖型糖尿病（IDDM）病情得到良好控制的受试者中，描述高血糖期（44小时）对胰岛素拮抗激素水平和胰岛素敏感性的影响。通过输注葡萄糖诱导高血糖（约15 mmol.L-1），同时胰岛素剂量与接近正常血糖水平（约6.9 mmol.L-1）时相似。在正常血糖（对照）期和高血糖期之前及之后4小时，采用高胰岛素正常血糖钳夹技术测量胰岛素敏感性。在每项研究的第二次钳夹中输注D-[3-3H]葡萄糖，以评估葡萄糖的生成和利用。由于糖尿病控制不佳时生长激素（GH）水平常常升高，因此在正常血糖期和高血糖期连续采集24小时血样，测量GH的昼夜分泌情况。对照期和高血糖期以及钳夹期间，肾上腺素、去甲肾上腺素、皮质醇和非酯化游离脂肪酸（NEFA）的水平相似。GH水平也相似，但出现了异常的昼夜分泌模式，白天峰值数量增加。高血糖并未降低IDDM患者的GH分泌。44小时的高血糖诱导了胰岛素抵抗（葡萄糖输注速率降低32%，P <.02）。在对照研究中，葡萄糖处置率（Rd）降低了21%（P =.064，无统计学意义），这表明住院本身可能也会降低胰岛素敏感性。总之，高血糖期会导致IDDM患者出现胰岛素抵抗。尽管发现GH分泌模式异常，但这种胰岛素抵抗并非由胰岛素拮抗激素水平升高所致。（摘要截短至250字）
