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

我们之前已经证明，雾化的肺部分娩 胰岛素有效地将血糖水平降至正常水平 非胰岛素依赖型糖尿病患者的空腹范围 (JAMA 269：2106-2109,1993)。在这项研究中，我们调查了 雾化吸入胰岛素可降低血糖 在用餐后。在两次随机访问中，7名NIDDM患者吸入了 平均约1.5U/kg体重的常规端口胰岛素 (礼来公司)或安慰剂气雾剂5分钟后摄入681卡路里 吃饭。气雾剂是由喷射雾化器输送系统产生的(Health Line Medical)，并连续吸入3.94正负1.18 最小。在进餐前和进餐后一小时采集血浆样本 并分析了葡萄糖、胰岛素和C-肽(一种 内源性胰岛素分泌)水平。餐后，血糖 在胰岛素治疗中，胰岛素水平显著降低(正负140 34 mg/dl)高于安慰剂组(250+或-79 mg/dl)(p< 0.01)。平均胰岛素水平在一小时后显著升高 吸入胰岛素(89.8+或-34.9 uu/ml)与安慰剂的比较 (40.4正负22.0 UU/ml)(p<0.05)。很可能是 胰岛素水平的增加主要是由于雾化吸入造成的。 胰岛素，因为餐后C-肽水平对胰岛素的访问是 显著低于安慰剂(1.53正负0.70 ng/ml) (2.96正负1.13 ng/ml)(p<0.01)。无副作用 报告是在吸入胰岛素或安慰剂气雾剂后发生的。这些 结果表明，雾化胰岛素，通过肺部输送，可能 是控制的有效替代管理途径 NIDDM患者餐后血糖水平的研究

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.