Moberg E, Hagström-Toft E, Arner P, Bolinder J
Department of Medicine, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden.
Diabetologia. 1997 Nov;40(11):1320-6. doi: 10.1007/s001250050827.
The absolute glucose concentrations in subcutaneous adipose tissue and skeletal muscle were determined with microdialysis in 10 normal-weight, healthy subjects during a standardized hyperinsulinaemic hypoglycaemic clamp. The concentration of tissue dialysate glucose was measured in 15-min fractions and compared with that in arterialized venous plasma. Insulin (0.15 U x kg(-1) x h[-1]) was infused i.v. to lower the plasma glucose level to 2.5 mmol/l over 30 min. This level was maintained for 30 min by using a variable glucose infusion. Thereafter, the insulin infusion was stopped and the plasma glucose level was gradually increased to baseline levels over 120 min. During a 60-min basal period, the glucose levels in muscle were 0.6 mmol/l lower than those in plasma (p = 0.002), whereas the levels in adipose tissue and plasma were similar. The glucose nadirs in muscle (1.6 +/- 0.1 mmol/l) and adipose tissue (2.0 +/- 0.1 mmol/l) were significantly lower than that in plasma (2.4 +/- 0.1 mmol/l) (p = 0.001 and 0.02, respectively), and the time-to-nadir was substantially longer in muscle (69 +/- 5 min) and adipose tissue (57 +/- 2 min) than in plasma (39 +/- 3 min) (p = 0.0004). When the insulin infusion was stopped, the increases in adipose tissue and muscle glucose concentrations were delayed by approximately 25 and 45 min, respectively, as compared to the increase in plasma glucose. Thus, it seems that glucose measurements in adipose tissue and muscle more adequately reflect overall tissue homeostasis than do measurements in blood and that clinically relevant tissue glucopenia may be overlooked by conventional blood glucose measurements.
在标准化的高胰岛素低血糖钳夹试验中,对10名体重正常的健康受试者采用微透析法测定皮下脂肪组织和骨骼肌中的绝对葡萄糖浓度。每15分钟测量一次组织透析液葡萄糖浓度,并与动脉化静脉血浆中的浓度进行比较。静脉输注胰岛素(0.15 U·kg⁻¹·h⁻¹),在30分钟内将血浆葡萄糖水平降至2.5 mmol/L。通过可变葡萄糖输注将该水平维持30分钟。此后,停止胰岛素输注,在120分钟内将血浆葡萄糖水平逐渐升至基线水平。在60分钟的基础期内,肌肉中的葡萄糖水平比血浆中的低0.6 mmol/L(p = 0.002),而脂肪组织和血浆中的水平相似。肌肉(1.6±0.1 mmol/L)和脂肪组织(2.0±0.1 mmol/L)中的葡萄糖最低点显著低于血浆中的(2.4±0.1 mmol/L)(分别为p = 0.001和0.02),并且肌肉(69±5分钟)和脂肪组织(57±2分钟)达到最低点的时间比血浆(39±3分钟)长得多(p = 0.0004)。当停止胰岛素输注时,与血浆葡萄糖升高相比,脂肪组织和肌肉葡萄糖浓度的升高分别延迟了约25分钟和45分钟。因此,与血液测量相比,脂肪组织和肌肉中的葡萄糖测量似乎更能充分反映整体组织内环境稳定,并且传统的血糖测量可能会忽略临床上相关的组织低血糖情况。