EFFICACY OF ORALLY INHALED INSULIN IN LOWERING GLUCOSE AFTER A MEAL IN DIABETICS

我们以前已经表明，雾化吸入的肺部输送 胰岛素有效地将血浆葡萄糖水平降低到正常范围内 空腹非胰岛素依赖型糖尿病患者的范围 (JAMA 269：2106-2109，1993）。 在这项研究中，我们调查了 雾化胰岛素的肺部给药降低血浆葡萄糖 饭后。 在两次随机访视中，7名NIDDM患者吸入 平均约1.5 U/kg体重的常规输液港胰岛素 (Eli礼来公司）或安慰剂气雾剂前5分钟摄入681卡路里 餐 气溶胶通过喷射雾化器递送系统（Health Line Medical），并持续吸入3.94 ± 1.18 分钟 在餐前和餐后1小时采集血浆样本 并分析葡萄糖、胰岛素和C-肽（ 内源性胰岛素分泌）水平。 餐后血糖 在胰岛素治疗时水平显著降低（140 ± 100 34 mg/dl）比安慰剂组（250 ± 79 mg/dl）（p <0.05）。 0.01）。 平均胰岛素水平显著高于一小时后， 与安慰剂相比，吸入胰岛素（89.8 ± 34.9 uU/ml） (40.4± 22.0 μ U/ml）（p <0.05）。 很可能 胰岛素水平的增加主要是由于雾化吸入 胰岛素，因为胰岛素访视时餐后C肽水平 显著低于（1.53 ± 0.70 ng/ml）安慰剂组 (2.96± 1.13 ng/ml）（p <0.01）。 没有副作用 在吸入胰岛素或安慰剂气雾剂后报告。 这些 结果表明，通过肺部输送的雾化胰岛素可能 是一种有效的替代给药途径， NIDDM患者餐后血糖水平。

We have shown, previously, that the pulmonary delivery of nebulized insulin effectively lowers plasma glucose level to within the normal range in fasting patients with non-insulin dependent diabetes mellitus (JAMA 269:2106-2109, 1993). In this study, we investigated whether pulmonary administration of nebulized insulin lowers plasma glucose after a meal. On two randomized visits, seven NIDDM patients inhaled an average of approximately 1.5 U/kg body weight regular port insulin (Eli Lilly) or placebo aerosol 5 minutes before ingesting a 681 calorie meal. Aerosol was generated by a jet nebulizer delivery system (Health Line Medical) and was inhaled continuously for 3.94 plus or minus 1.18 min. Plasma samples were collected before and one hour after the meal and analyzed for glucose, insulin and c-peptide (an indicator of endogenous secretion of insulin) levels. After the meal, plasma glucose levels were significantly lower on the insulin visit (140 plus or minus 34 mg/dl) than with placebo (250 plus or minus 79 mg/dl) (p less than 0.01). Mean insulin levels were significantly higher one hour after inhaling insulin (89.8 plus or minus 34.9 uU/ml) compared to placebo (40.4 plus or minus 22.0 uU/ml) (p less than 0.05). It is likely that this increase in insulin levels was due predominantly to nebulized insulin, since c-peptide levels after the meal on the insulin visit were significantly less (1.53 plus or minus 0.70 ng/ml) than with placebo (2.96 plus or minus 1.13 ng/ml) (p less than 0.01). No side effects were reported after inhalation of insulin or placebo aerosols. These results suggest that nebulized insulin, delivered through the lungs, may be an effective alternative route of administration for controlling plasma glucose levels after a meal in patients with NIDDM.