PERIPRANDIAL REGULATION OF LIPID-METABOLISM IN INSULIN-TREATED DIABETES-MELLITUS
PERIPRANDIAL REGULATION OF LIPID-METABOLISM IN INSULIN-TREATED DIABETES-MELLITUS
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DOI：
10.1016/0026-0495(93)90110-a
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发表时间：
1993-04-01
影响因子：
9.8
通讯作者：
EVANS, RD
中科院分区：
文献类型：
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作者：
FRAYN, KN;COPPACK, SW;EVANS, RD
我们研究了6例接受胰岛素治疗的糖尿病患者在吸收后和餐后状态下的脂质和葡萄糖代谢调节，并将其与8例非糖尿病患者进行了比较。在禁食过夜和混合餐（3.1 MJ，41%来自脂肪）后6小时，研究了代谢物的血液或血浆浓度以及前臂和皮下脂肪组织的通量。在吸收后状态下，两组的脂质代谢调节似乎基本相似，除了糖尿病组血浆（游离）胰岛素浓度分布更广，导致脂肪组织释放的血浆非酯化脂肪酸（NEFA）、血浆NEFA浓度和血酮体浓度的值范围更广。在两组中，脂肪组织中酮体的提取与动脉浓度呈正相关（与前臂中一样），证实了人体脂肪组织利用酮体的能力。糖尿病组餐前单次皮下注射胰岛素产生的血浆游离胰岛素曲线与对照组餐后反应相比变钝且延长。餐后前臂葡萄糖摄取非常密切地跟随血浆（游离）胰岛素浓度。在糖尿病组中，餐后抑制脂肪组织NEFA释放基本上是正常的，并且非常接近地再现了正常的餐后血浆NEFA浓度降低。前臂和脂肪组织血流量在两组之间没有差异。结果表明，在进食的生理背景下，血糖控制良好的胰岛素治疗糖尿病受试者（血红蛋白A1[HbA1]，< 10.5%）的葡萄糖和脂质代谢的调节并未根本受损，但吸收后至餐后过渡的协调确实取决于获得适当的血浆游离胰岛素浓度曲线。
We have examined the regulation of lipid and glucose metabolism in the postabsorptive and postprandial states in six subjects with insulin-treated diabetes mellitus, and compared them with eight nondiabetic subjects. Blood or plasma concentrations of metabolites and fluxes across forearm and subcutaneous adipose tissue were studied after an overnight fast and for 6 hours after a mixed meal (3.1 MJ, 41% from fat). In the postabsorptive state, regulation of lipid metabolism in the two groups appeared basically similar except that a wider spread of plasma (free) insulin concentrations in the diabetic group led to a wider range of values of plasma nonesterified fatty acid (NEFA) release from adipose tissue, plasma NEFA concentrations, and blood ketone body concentrations. Extraction of ketone bodies across adipose tissue was positively correlated with arterial concentration in both groups (as it was in the forearm), confirming the ability of human adipose tissue to utilize ketone bodies. A single subcutaneous injection of insulin before the meal in the diabetic group produced a plasma free-insulin profile that was blunted and prolonged compared with the postprandial response in the control group. Postprandial forearm glucose uptake followed very closely the plasma (free) insulin concentration. Postprandial suppression of NEFA release from adipose tissue was essentially normal in the diabetic group, and the normal postprandial decrease in plasma NEFA concentrations was reproduced extremely closely. Forearm and adipose tissue blood flow did not differ between the groups. The results show that the regulation of glucose and lipid metabolism is not fundamentally impaired in well-controlled insulin-treated diabetic subjects (hemoglobin A1[HbA1], < 10.5%) in the physiological context of meal ingestion, but that coordination of the postabsorptive to postprandial transition does depend on achieving a suitable profile of plasma free-insulin concentrations.