Differential effects of fasting and dehydration in the pathogenesis of diabetic ketoacidosis
Differential effects of fasting and dehydration in the pathogenesis of diabetic ketoacidosis
复制标题
DOI：
10.1053/meta.2001.20194
复制
发表时间：
2001-02-01
影响因子：
9.8
通讯作者：
Schade, DS
中科院分区：
文献类型：
--
作者：
Burge, MR;Garcia, N;Schade, DS
糖尿病酮症酸中毒（DKA）患者的血糖差异很大，常见的血浆葡萄糖浓度在10至50 mmol/L之间。这种血糖变异性的机制尚不确定。我们的研究检测了1型糖尿病患者停用胰岛素后，禁食和脱水对高血糖的不同影响。为了评估脱水和禁食在DKA发病机制中的各自作用，对25名1型糖尿病患者在胰岛素停用前（对照）以及禁食32小时（n = 10）或脱水至基线体重的4.1%±2.0%（n = 15）之后的5小时内进行了研究。在胰岛素停用期间，每隔30分钟采集样本，检测底物和反调节激素水平以及葡萄糖生成和代谢速率。与对照研究相比，禁食导致血浆葡萄糖浓度降低，而脱水导致血浆葡萄糖浓度升高（P <.001）。与对照研究相比，禁食研究中葡萄糖生成和代谢降低，脱水研究中则升高。与对照相比，禁食和脱水过程中胰高血糖素浓度以及酮症和代谢性酸中毒的发展速率均升高。这些数据表明，在胰岛素缺乏期间，禁食和脱水对血糖有不同的影响，脱水有利于高血糖的发展，而禁食导致葡萄糖浓度降低。这一发现可能归因于这些情况对内源性葡萄糖生成的不同影响，以及底物可利用性和反调节激素浓度的差异。先前存在的禁食和脱水的严重程度可能解释了在DKA中观察到的血浆葡萄糖浓度的大部分变异性。版权所有（C）2001，W.B.桑德斯公司。
Glycemia varies widely in patients with diabetic ketoacidosis (DKA), with plasma glucose concentrations between 10 to 50 mmol/L commonly encountered. The mechanism of this glycemic variability is uncertain. Our study examined the differential effects of fasting and dehydration on hyperglycemia induced by withdrawal of insulin in type 1 diabetes. To evaluate the respective roles of dehydration and fasting in the pathogenesis of DKA, 25 subjects with type 1 diabetes were studied during 5 hours of insulin withdrawal before (control) and after either 32 hours of fasting (n = 10) or dehydration of 4.1% +/- 2.0% of baseline body weight (n = 15). Samples were obtained every 30 minutes during insulin withdrawal for substrate and counterregulatory hormone levels and rates of glucose production and disposal. Fasting resulted in reduced plasma glucose concentrations compared with the control study, while dehydration resulted in increased plasma glucose concentrations compared with the control study (P < .001). Glucose production and disposal were decreased during the fasting study and increased during the dehydration study compared with the control study. Glucagon concentrations and rates of development of ketosis and metabolic acidosis were increased during both fasting and dehydration compared with control. These data suggest that fasting and dehydration have differential effects on glycemia during insulin deficiency, with dehydration favoring the development of hyperglycemia and fasting resulting in reduced glucose concentrations. This finding is probably attributable to the differing effect of these conditions on endogenous glucose production, as well as to differences in substrate availability and counterregulatory hormone concentrations. The severity of pre-existing fasting and dehydration likely explains much of the variability in plasma glucose concentrations observed in DKA. Copyright (C) 2001 by W.B. Saunders Company.