Scheen A J, Lefèbvre P J
Department of Medicine, CHU Liège, Belgium.
Diabetes Metab. 1996 Apr;22(2):105-10.
Insulin action is crucial for the regulation of glucose metabolism. Insulin plays a key role in suppressing endogenous glucose production by the liver, both in fasting and postprandial states. Insulin is also necessary for the maintenance of normal rates of glucose oxidation and storage in insulin-sensitive tissues and for the prevention of excessive gluconeogenic substrate production. Various methods have been developed to assess insulin action in vivo, essentially at liver and muscle sites. Such methods evaluate the effect of exogenous or endogenous insulin, using respectively the open-loop approach (interruption of the feedback loop by inhibiting endogenous insulin secretion) or the closed-loop approach (mathematical modelling of the insulin-glucose feedback loop). Knowledge of the successive steps of cellular insulin action has markedly improved during the last ten years. Preceptor, receptor and postreceptor levels need to be considered since they may be affected in insulin-resistant states. This general progress in the understanding of insulin action in man improves our approach to the complex pathophysiology of non-insulin-dependent diabetes mellitus and opens up new prospects for treatment of the insulin-resistant syndrome which is associated with several atherosclerotic risk factors.
胰岛素作用对于葡萄糖代谢的调节至关重要。胰岛素在抑制肝脏内源性葡萄糖生成方面起着关键作用，无论是在空腹还是餐后状态。胰岛素对于维持胰岛素敏感组织中正常的葡萄糖氧化和储存速率以及防止过多的糖异生底物产生也是必需的。已经开发出各种方法来评估体内胰岛素作用，主要是在肝脏和肌肉部位。这些方法分别使用开环方法（通过抑制内源性胰岛素分泌中断反馈回路）或闭环方法（胰岛素 - 葡萄糖反馈回路的数学建模）来评估外源性或内源性胰岛素的作用。在过去十年中，对细胞胰岛素作用连续步骤的认识有了显著提高。由于在胰岛素抵抗状态下前受体、受体和受体后水平可能会受到影响，因此需要对它们进行考虑。对人类胰岛素作用理解的这一总体进展改善了我们对非胰岛素依赖型糖尿病复杂病理生理学的认识，并为与多种动脉粥样硬化危险因素相关的胰岛素抵抗综合征的治疗开辟了新前景。
