Effects of acute insulin excess and deficiency on gluconeogenesis and glycogenolysis in type 1 diabetes
Effects of acute insulin excess and deficiency on gluconeogenesis and glycogenolysis in type 1 diabetes
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DOI：
10.2337/diabetes.52.1.133
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发表时间：
2003-01-01
期刊：
影响因子：
7.7
通讯作者：
Homko, C
中科院分区：
文献类型：
--
作者：
Boden, G;Cheung, P;Homko, C
为了确定胰岛素是否通过改变糖异生（GNG）、糖原溶解（GL）或两者同时改变而引起内源性葡萄糖生成（EGP）的急性变化，我们测量了9例1型糖尿病患者在皮下注射胰岛素产生的急性胰岛素过量和胰岛素缺乏期间（胰岛素注射后5至8小时）的GNG（用(H2O)-H-2）和GL （EGP-GNG）。在胰岛素过量期间，游离胰岛素浓度增加了5倍（从36到180 pmol/l）。血浆葡萄糖维持在6.2 ~ 6.7 mmol/l之间，与静脉滴注葡萄糖维持4小时相似。1小时后，EGP（含6,6- h -2葡萄糖）从17.1 μ mol (.) kg(-1) (.) min（-1）下降到9.8 μ mol (.) kg(-1) (.) min(-1)，几乎完全归因于GL的下降(从10.7 μ mol (.) kg(-1) （.) min(-1)）。胰岛素缺乏时，血糖从6.2升高到10.5 mmol/l， EGP从9.5升高到14.3 mmol/ kg min， EGP的升高再次与GL升高有关。由此可见，胰岛素对1型糖尿病急性期EGP的调节主要是通过GL的改变，而GNG在急性胰岛素过量或缺乏的早期变化不大。
To determine whether insulin induces acute changes in endogenous glucose production (EGP) via changes in gluconeogenesis (GNG), glycogenolysis (GL), or both, we measured GNG (with (H2O)-H-2) and GL (EGP-GNG) in nine patients with type 1 diabetes during acute insulin excess produced by subcutaneous injection of insulin and during insulin deficiency which developed between 5 and 8 h after insulin injection. During insulin excess, free insulin concentration rose fivefold (from 36 to 180 pmol/l). Plasma glucose was maintained between 6.2 and 6.7 mmol/l for similar to4 h with IV glucose. EGP (with 6,6-H-2 glucose) decreased from 17.1 to 9.8 mumol (.) kg(-1) (.) min(-1) after 1 h. This decrease was almost completely accounted for by a decrease in GL (from 10.7 to 4.6 mumol (.) kg(-1) (.) min(-1)). During insulin deficiency, plasma glucose rose from 6.2 to 10.5 mmol/l and EGP from 9.5 to 14.3 mumol/kg min. The increase in EGP again was accounted for by an increase in GL.We conclude that in type 1 diabetes acute regulation of EGP by insulin is mainly via changes in GL while GNG changes little during the early hours of acute insulin excess or deficiency.