Lyrenås E B, Olsson E H, Arvidsson U C, Orn T J, Spjuth J H
Department of Internal Medicine, Central Hospital, Karlskrona, Sweden.
Diabetes Care. 1997 Mar;20(3):413-8. doi: 10.2337/diacare.20.3.413.
To compare postprandial blood glucose levels with gastric emptying (GE) time after intake of a solid and a nutrient liquid meal in patients with unstable, type I diabetes.
The subjects studied were 15 patients with long-standing type I diabetes who during the last year repeatedly reported unexplained episodes of instability in their blood glucose regulation, including postprandial hypoglycemia. All patients were on a meal-administered, fast-acting insulin regimen. As control group, 19 healthy subjects were studied. GE was measured at two separate occasions, using a gamma camera after intake of either a solid or a nutrient liquid, isotope-labeled meal. Measurement of GE was done directly after meal completion and at 30-min intervals for 2 h. Insulin was taken 30 min before intake of the meal. Blood glucose was measured 30 min before the meal, after meal completion and at 30, 60, 90, and 120 min after start of the meal. All patients were evaluated for evidence of autonomic neuropathy and were asked for signs of gastrointestinal motor dysfunction.
Seven (44%) of the patients had significantly delayed emptying of the solid meal (three men, four women) (P < 0.01), of whom one woman also had delayed emptying of the liquid meal compared with the healthy control subjects. Changes in blood glucose concentration were correlated to GE time with, in the group with delayed GE, a significant fall after the solid meal compared with the liquid meal (P < 0.05). The lag phase was prolonged in the women compared with the men, reaching significance in the patient group (P < 0.01). The women, patients as well as control subjects, had throughout the study a prolonged emptying time compared with the men after both the solid and the liquid meal. No correlation between GE and blood glucose concentration could be found.
Delayed GE of a solid meal is commonly found in patients with type I diabetes and may be one cause of unstable blood glucose regulation. Women, patients as well as control subjects, seem to have a more prolonged GE than men. Awareness of gastric function in patients with type I diabetes is essential, especially in patients treated with meal-administered, fast-acting insulin.
比较不稳定型1型糖尿病患者摄入固体餐和营养液餐后的餐后血糖水平与胃排空（GE）时间。
研究对象为15例长期患1型糖尿病的患者，他们在过去一年中多次报告血糖调节出现不明原因的不稳定情况，包括餐后低血糖。所有患者均采用餐时注射速效胰岛素的治疗方案。作为对照组，研究了19名健康受试者。在摄入固体或营养液同位素标记餐之后，使用γ相机在两个不同时间点测量胃排空。在餐后立即以及之后2小时内每隔30分钟测量一次胃排空。在进餐前30分钟注射胰岛素。在进餐前30分钟、餐后以及进餐开始后30、60、90和120分钟测量血糖。对所有患者进行自主神经病变证据评估，并询问胃肠道运动功能障碍的体征。
7例（44%）患者固体餐排空明显延迟（3名男性，4名女性）（P<0.01），其中1名女性与健康对照受试者相比，营养液餐排空也延迟。血糖浓度变化与胃排空时间相关，在胃排空延迟组中，固体餐后血糖较营养液餐后显著下降（P<0.05）。与男性相比，女性的延迟期延长，在患者组中具有统计学意义（P<0.01）。在整个研究过程中，女性患者和女性对照受试者在摄入固体餐和营养液餐后的排空时间均比男性延长。未发现胃排空与血糖浓度之间存在相关性。
1型糖尿病患者中固体餐胃排空延迟常见，可能是血糖调节不稳定的原因之一。女性患者和女性对照受试者的胃排空时间似乎比男性更长。了解1型糖尿病患者的胃功能至关重要，尤其是在用餐时注射速效胰岛素治疗的患者中。
