EFFECTS OF INSULIN ON PERIPHERAL AND SPLANCHNIC GLUCOSE-METABOLISM IN NONINSULIN-DEPENDENT (TYPE-II) DIABETES-MELLITUS
EFFECTS OF INSULIN ON PERIPHERAL AND SPLANCHNIC GLUCOSE-METABOLISM IN NONINSULIN-DEPENDENT (TYPE-II) DIABETES-MELLITUS
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DOI：
10.1172/jci111938
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发表时间：
1985-01-01
影响因子：
15.9
通讯作者：
WAHREN, J
中科院分区：
文献类型：
--
作者：
DEFRONZO, RA;GUNNARSSON, R;WAHREN, J
本文对9例正常体重的非胰岛素依赖型糖尿病（NIDD）患者进行了胰岛素抵抗（IR）机制和部位的研究。正葡萄糖胰岛素钳夹技术（胰岛素浓度约为0.0000000）可用于治疗糖尿病。100 μ U/ml）与肝和股静脉导管插入术和使用氚化葡萄糖输注测量内源性葡萄糖产生相结合。NIDD受试者的全身葡萄糖代谢（4.37 ±. 0.45 mg/kg/min）比对照组（7.04 ± 0.01）低38%（P < 0.01）。0.63 mg/kg/min）。定量分析发现，胰岛素抵抗最重要的部位是外周组织。与对照组相比，糖尿病组的腿部葡萄糖摄取减少了45%（6.0 ± 0.5%）。0.2与11.0 .+-相比。0.1 mg/kg腿重/min; P.< 0.01）。腿部葡萄糖摄入量与全身葡萄糖摄入量呈强正相关（r = 0.70，P < 0.001）。假设肌肉是负责葡萄糖摄取的主要腿部组织，可以估计对照组和NIDD受试者中分别有90%和87%的输注葡萄糖被外周组织处理。在胰岛素刺激过程中，对照组的净内脏葡萄糖平衡比糖尿病受试者略高（0.31 ± 0.05）。0.10相对于0.05 ± 0.05。01.0相对于0.05 ± 0.05。0.19 mg/kg/min; P < 0.07）。NIDD组净内脏葡萄糖平衡的差异（0.26 mg/kg/min）仅占NIDD组全身葡萄糖摄入减少（2.67 mg/kg/min）的10%，因此对胰岛素抵抗的贡献很小。结果强调了外周组织在处理输注葡萄糖中的重要性，并表明肌肉是NIDD胰岛素抵抗的最重要部位。
The mechanism(s) and site(s) of the insulin resistance were examined in 9 normal-weight noninsulin-dependent diabetic (NIDD) subjects. The euglycemic insulin clamp technique (insulin concentration .apprx. 100 .mu.U/ml) was employed in combination with hepatic and femoral venous catheterization and measurement of endogenous glucose production using infusion of tritiated glucose. Total body glucose metabolism in the NIDD subjects (4.37 .+-. 0.45 mg/kg per min) was 38% (P < 0.01) lower than in controls (7.04 .+-. 0.63 mg/kg per min). Quantitatively, the most important site of the insulin resistance was found to be in peripheral tissues. Leg glucose uptake in the diabetic group was reduced by 45% as compared with that in controls (6.0 .+-. 0.2 vs. 11.0 .+-. 0.1 mg/kg leg wt per min; P. < 0.01). A strong positive correlation was observed between leg and total body glucose uptake (r = 0.70, P < 0.001). Assuming that muscle is the primary leg tissue responsible for glucose uptake, it could be estimated that 90 and 87% of the infused glucose was disposed of by peripheral tissues in the control and NIDD subjects, respectively. Net splanchnic glucose balance during insulin stimulation was slightly more positive in the control than in the diabetic subjects (0.31 .+-. 0.10 vs. 0.05 .+-. 01.0 vs. 0.05 .+-. 0.19 mg/kg per min; P < 0.07). The difference (0.26 mg/kg per min) in net splanchnic glucose balance in NIDD represented only 10% of the reduction (2.67 mg/kg per min) in total body glucose uptake in the NIDD group and thus contributed very little to the insulin resistance. The results emphasize the importance of the peripheral tissues in the disposal of infused glucose and indicate that muscle is the most important site of the insulin resistance in NIDD.