原发性肝癌并发糖代谢紊乱

目的探讨原发性肝癌并发糖代谢紊乱的可能发生机制.方法测定 70例原发性肝癌患者空腹血糖、空腹及餐后2小时胰岛素、C肽浓度.对检测结果进行统计分析,组间分析采用t检验.结果原发性肝癌并发糖代谢紊乱44.29% (31/70),其中低血糖占25.71%(18/70),其空腹胰岛素及C肽浓度均正常,与对照组比较差异无显著性.并发高血糖占18.6%(13/70),其空腹胰岛素、餐后 2小时胰岛素、C肽浓度均显著升高,与对照组比较有显著性差异(p<0.01).结论原发性肝癌并发低血糖可能与肝葡萄糖产生率降低及葡萄糖利用率增加有关.原发性肝癌伴高血糖可能与调节血糖激素灭活障碍及胰岛素抵抗有关.     

肝炎后肝硬化并糖代谢紊乱41例临床分析

目的 探讨肝炎后肝硬化并糖代谢紊乱的临床特点。方法 对肝硬化病人空腹血糖，餐后两小时血糖监测。结果 肝炎后肝硬化患者出现糖代谢紊乱（61.2％）；空腹血糖升高，餐后两小时血糖升高及空腹低血糖均不同比率出现。结论 对肝炎后肝硬化病人血糖监测有重要临床意义。     

LADA实验室诊断方法初步探讨

对成人晚发自身免疫性糖尿病（LADA）早期诊断,用胰岛素治疗,有利于保护残留部分胰岛β细胞功能,延缓病情的发展。本文通过对三组病人及一组正常者,用酶免疫和放射免疫法测定血糖、血清C肽、血清谷氨酸脱梭酶抗体（GAD-Ab）,比较其相关性,得出LADA实验室诊断指标。对新发病的糖尿病病人,年龄20-40岁,发病时"三多"症状明显,口服降糖药血糖难以控制,无诱因而出现酮体,应测空腹血糖、C肽,馒头餐后1小时、2小时C肽,并测GAD-Ab。若空腹血糖大于13．0mmol／L,空腹C肽小于0．5nmol／L,餐后1小时、2小时C肽均低于0．85nmol／L,且GAD-Ab阳性者,可诊断为LADA;若GAD-Ab阴性,但空腹血糖很高,空腹及餐后1小时、2小时C肽明显低于正常,也应高度怀疑为LADA。     

原发性高血压和冠心病患者胰岛素和C-肽的临床观察

目的：观察原发性高血压（EH）和冠心病（CHD）患者的胰岛素抵抗及其差异。方法：检测原发性高血压（EH）52例,冠心病（CHD）47例和健康对照组35例的空腹和服糖2h后胰岛素和C-肽,并进行比较。结果：原发性高血压病人和冠心病人空腹及服糖后2h血糖、胰岛素和C-肽明显高于正常健康人（P〈0.01）。结论：原发性高血压和冠心病患者存在胰岛素抵抗、高胰岛素血症、高C-肽水平。     

测定血清INS、C-P对原发性高血压患者的临床意义

为探讨测定血清胰岛素（INS）,C－肽（C－P）对原发性高血压（EH）患者的应用价值,对32例EH患者的空腹和餐后2小时血糖（BG）、INS、C－P等指标进行测定,计算胰岛素敏感指数（ISI）,并与40名对照组进行比较,结果发现,EH组与对照组空腹血糖无明显差异,而空腹INS及餐后2小时BG、INS、C－P均明显高于对照组（P＜0．01）;胰岛素抵抗、高胰岛素血症比例均明显高于对照组（P＜0．01）。提示EH除血管和血液动力学异常外,尚存在多种物质代谢异常,同时血清INS、C－P的RIA测定在糖尿病以外疾病中的应用前景也很广扩。．     

瑞格列奈加甘精胰岛素治疗磺脲类药物失效疗效观察

目的观察瑞格列奈加甘精胰岛素治疗磺脲类药物失效疗效。方法60例2型糖尿病患者口服磺脲类药物失效,随机分为瑞格列奈加甘精胰岛素组26例和胰岛素泵组34例,观察空腹和餐后2h血糖、C肽,糖化血红蛋白治疗前后变化。结果两组治疗前后空腹和餐后2 h血糖、糖化血红蛋白均明显下降,空腹和餐后2 h C肽明显升高（P〈0.05）,低血糖发生率胰岛素泵组高于瑞格列奈组（P〈0.05）,血糖达标时间瑞格列奈组长于胰岛素泵组（P〈0.05）。结论瑞格列奈控制餐后血糖、甘精胰岛素提供基础胰岛素能有效模拟生理胰岛素分泌,有效控制血糖,且价廉、依从性好,虽达标时间稍长也是值得推广的好方法。     

胰岛素抵抗患者的血脂代谢紊乱

目的　探讨胰岛素抵抗患者的血脂代谢紊乱 .方法　空腹及口服葡萄糖后 1小时、2小时、3小时分别抽静脉血 ,测定血糖、胰岛素、C肽、血脂 .结果　胰岛素抵抗患者的血脂代谢有明显紊乱 ,以总胆固醇、甘油三脂增高最多见为特征 .结论　胰岛素抵抗患者有明显血脂代谢紊乱 ,此对早期预防及诊断动脉粥样硬化、2型糖尿病可能存在重要价值 .     

胰岛素抵抗患者的血脂代谢紊乱

目的探讨胰岛素抵抗患者的血脂代谢紊乱.方法空腹及口服葡萄糖后1小时、2小时、3小时分别抽静脉血,测定血糖、胰岛素、C肽、血脂.结果胰岛素抵抗患者的血脂代谢有明显紊乱,以总胆固醇、甘油三脂增高最多见为特征.结论胰岛素抵抗患者有明显血脂代谢紊乱,此对早期预防及诊断动脉粥样硬化、2型糖尿病可能存在重要价值.     

空腹血糖正常的冠心病患者糖代谢状况及胰岛素水平分析

目的：探讨空腹血糖正常的冠心病患者的糖代澍状况及胰岛素敏感性的改变。方法：检测67例空腹血糖正常的冠心病住院患者和35例健康者的空腹及餐后2h的血糖和胰岛索水平,并根据餐后2h血糖结果将冠心病患者分为3组：正常糖耐量组（NGT）、单纯性糖耐量受损组（I—IGT）、单纯性负荷后高血精组（IPH）。应用李光伟指数（IAI）评价机体的胰岛素敏感性。结果：67例空腹血糖正常的冠心病患者中糖代谢异常的发生率为74．63％,所有冠心病患音餐后胰岛素水平显著高于正常对照组（P〈0．05）,IPH组的胰岛素敏感性显著低于其他各组（P均〈0．05）。结论：空腹血糖正常的冠心病患者中绝大多数合并糖代谢异常,并存在高胰岛索血症,合并IPH的冠心病患者胰岛素的敏感性较低。检测餐后血糖和胰岛素对冠心病患者合并糖代谢异常的预防、诊断、疗效评估有重要意义。     

中效胰岛素联合糖适平与预混胰岛素治疗2型糖尿病临床效果研究

目的 研究预混胰岛素血糖控制不佳的2型糖尿病患者改为糖适平与中效胰岛素联合降糖的效果.方法 选取我院收治的56例2型糖尿病患者,将其随机分为观察组以及对照组,观察组采用中效胰岛素联合糖适平治疗,对照组采用早晚两次注射预混胰岛素方式治疗,比较两组治疗后第5天患者的空腹血糖、平均餐后血糖、胰岛素用量及低血糖发生情况.结果 治疗后5d,观察组患者的空腹血糖、平均餐后2小时血糖均明显低于对照组,治疗后2个月复查糖化血红蛋白水平观察组明显低于对照组,组间比较差异有统计学意义(P＜0.05),两组胰岛素用量比较差异无统计学意义(P＞0.05),两组均出现1例低血糖.结论 中效胰岛素可以明显改善空腹血糖,但对餐后血糖控制欠佳者,联合糖适平治疗可以很好地克服这一问题,早晚两针中效胰岛素联合口服糖适平治疗降糖效果优于预混胰岛素治疗.     

Symptoms of hypoglycemia — A comparison between porcine and human insulin

Summary For more than 2 years now it has been controversially debated whether awareness of hypoglycemia is reduced when type I diabetic patients are switched from porcine to human insulin. In order to address this question, we studied nine C-peptide negative diabetics (age 27.6 years, Broca index 106%, duration of diabetes 5.7 years, HbA₁, 8.8%) in comparison with eight healthy volunteers (age 22.4 years, Broca index 104%). Following euglycemic monitoring overnight, a controlled hypoglycemia was induced by altering the algorithms of the Biostator. This was done in a double-blind, cross-over fashion using porcine or human insulin on 2 nonconsecutive days. There were no differences between the results obtained with respect to the time course of the study, blood glucose, amount of insulin infused, and concentration of venous free insulin achieved. Of the nine diabetics, eight were aware of hypoglycemia at a higher blood glucose level under porcine insulin. The first symptom of hypoglycemia was percieved at a mean blood glucose level of 61.1±5.4 mg/dl under porcine insulin and of 44.4 ± 5.3 mg/dl under human insulin (P0.05). Thirty symptoms were noted under porcine insulin exclusively or preferentially as opposed to only eight which were observed exclusively or preferentially under human insulin. The healthy volunteers evidenced fewer symptoms at lower blood glucose concentrations than the diabetics. The clear difference between human and porcine insulin could not unequivocally be reproduced in this group. We conclude that type I diabetic patients, who are maintained on a treatment regimen with human insulin, perceive symptoms of hypoglycemia at higher blood glucose concentrations when hypoglycemia is induced by porcine insulin as compared with human insulin. As every single patient and healthy volunteer was aware of at least one symptom of hypoglycemia under both insulins, it is possible to react appropriately to counteract this situation. Nevertheless, diabetic patients should be informed about this phenomenon.Abbreviations P porcine insulin - H human insulin - IU international units Supported by Nordisk Deutschland     

Familial hyperinsulinemia due to a structurally abnormal insulin. Definition of an emerging new clinical syndrome

We have identified a patient with mild diabetes, marked fasting hyperinsulinemia (89 to 130 microU of insulin per milliliter), and a reduced fasting C-peptide: insulin molar ratio of 1.11 to 1.50 (normal, greater than 4). The patient responded normally to exogenous insulin. However, her endogenous immunoreactive insulin showed reduced biologic activity during a glucose-clamp study with hyperglycemia and a reduced ability to bind to the insulin receptor and stimulate glucose transport in vitro. Family studies showed that five additional relatives in three generations had variable degrees of glucose intolerance, marked hyperinsulinemia, and a reduced peripheral C-peptide:insulin molar ratio. Restriction-endonuclease cleavage of DNA isolated from circulating leukocytes in the patient and in family members with hyperinsulinemia revealed loss of the MboII recognition site in one allele of the insulin gene--consistent with a point mutation at position 24 or 25 in the insulin B chain. Other studies using high-pressure liquid chromatography and detailed gene analysis have identified the defect as a serine for phenylalanine substitution at position 24 of the insulin B chain. The secretion of a structurally abnormal insulin should be considered in patients with hyperinsulinemia who respond normally to exogenous insulin and have a reduced C-peptide:insulin molar ratio. Glucose tolerance may range from relatively normal to overtly diabetic.     

幽门螺杆菌感染与轻度颈动脉狭窄患者OGTT水平的关联分析

目的 分析幽门螺杆菌感染与轻度颈动脉狭窄患者OGTT水平的关联.方法 选取颈动脉轻度狭窄患者105例,根据感染情况分为幽门螺杆菌感染组和非幽门螺杆菌感染组.分析幽门螺杆菌感染与轻度颈动脉狭窄患者OGTT水平的关联,应用SPSS 20.0进行分析.结果 OGTT实验中2组患者摄入葡萄糖后0.5h血糖水平达到最高峰值,然后开始下降,摄入葡萄糖后1h的血糖水平感染组显著高于非感染组(P＜0.05).胰岛素水平也是空腹水平较低,在摄入葡萄糖后0.5h水平达到最高峰值,然后开始下降,2组在5个时间点的胰岛素水平差异均有统计学意义(P＜0.05).C肽水平也是空腹水平较低,在摄入葡萄糖后0.5h水平达到最高峰值后下降.比较2组患者OGIT检测结果中的C肽水平在空腹状态下差别无统计学意义,摄人葡萄糖后检测的4个时间点差异均有统计学意义(P＜0.05).结论 Hp感染的患者糖代谢开始1h左右血糖水平与无Hp感染者的情况差别有统计学意义.在Hp感染的患者基础胰岛素水平值就较高,随着摄人葡萄糖以及糖代谢的开始,始终存在胰岛素水平高于无Hp感染者的情况.Hp感染的患者基础C肽水平值与非感染患者相当,随着摄人葡萄糖以及糖代谢的开始,始终存在C肽水平高于无Hp感染者的情况.     

Factitious hypoglycemia. Diagnosis by measurement of serum C-peptide immunoreactivity and insulin-binding antibodies.

In seven patients with factitious hypoglycemia due to the surreptitious injection of insulin, we made the diagnosis by measurements of plasma insulin and C-peptide immunoreactivity (in seven patients), facilitated by the finding of circulating insulin-binding antibodies (in two patients). The simultaneous demonstration of low plasma glucose, high immunoreactive insulin and suppressed C-peptide immunoreactivity represents a triad of results pathognomonic of exogenous insulin administration. Determination of plasma free C-peptide and free insulin permitted patients with high titers of insulin antibodies, including those with a history of insulin-treated diabetes, to be studied and diagnosed in a way similar to that in subjects who had no circulating insulin antibodies.     

Does alcohol promote reactive hypoglycemia in the rat?

Alcohol induces a reactive hypoglycemia in man, but divergent results have been reported, in man and rats, on the effects of ethanol plus a carbohydrate load. The interactions between ethanol and glucose metabolism are complex. In the present study isocaloric solutions of glucose alone (A) or glucose plus alcohol (B) were administered in rats at the beginning of nighttime. Their effects were compared on blood glucose (BG) levels. Since rats don't drink alcohol spontaneously, glucose was given by mouth and alcohol through an intragastric catheter (IG); in the case of glucose alone half the load was ingested by mouth, and half IG. After administration, BG level was continuously determined in freely moving rats. It was shown that the latency to eat after the ingestion of glucose plus alcohol was significantly shorter and the size of the meal smaller. The postabsorptive hyperglycemia was significantly decreased in B as compared to A. The following hypoglycemia was more severe in B and it appeared earlier. In addition, a stress was applied after both A and B. It is well known that stress are potent stimuli of the sympathetic nervous system which inhibits insulin secretion. In both situations (A and B) with stress, the small preabsorptive hypoglycemia which appeared 4 min after the ingestion was suppressed. The hyperglycemia was higher in situation A with, than without, stress. The subsequent hypoglycemia was significantly lower. After stress in B, there was no difference in the peak of hyperglycemia but it appeared later. So, in rat the ingestion of alcohol together with an oral glucose load could trigger a reactive hypoglycemia. Stress greatly enhanced the phenomenon.     

Characteristics of the postoperative period in diabetes mellitus type 1 in patients with distal splenorenal anastomosis

Eight patients with type I diabetes mellitus have been operated on to form a distal splenorenal anastomosis (DSRA). A critical period (the 6th and the 7th days) postoperation has been observed when severe metabolic acidosis develops; to prevent its development, transfusions of 4% sodium bicarbonate solution (1.5-2.01) have been administered before the critical period for 24 hrs, with the metabolic condition monitored by biochemical analyses. Studies of metabolism in these patients after surgery have revealed a complete normalization of the acid-base balance and of potassium level, as well as a reduction of the blood glucose concentration. The doses of exogenic insulin have been reduced by 30%, this being associated with a tendency to an increase of the levels of endogenic insulin, C-peptide and glucagon of the blood. This helps a better stabilization of the diabetic process after the formation of a DSRA.     

The investigation of glucose metabolism and insulin secretion in subjects of chronic hepatitis B with cirrhosis

Aims: To investigate the situations of abnormal glucose metabolism and dysfunction of pancreatic islet beta cells in subjects of chronic hepatitis B (CHB) with cirrhosis. Methods: 106 hepatitis B virus (HBV) positive subjects with liver cirrhosis as well as with different grade of Child-Pugh and 37 healthy subjects were included in this study. The oral glucose tolerance test (OGTT), C-peptide and insulin release test were detected. Plasma glucose and insulin levels were analyzed periodically for 2 h after oral glucose loading. Results: There was no significant difference in the level of fasting plasma glucose and C-peptide between cirrhosis group and control group (P>0.05). The levels of OGTT 2 h glucose, insulin and C peptide were significantly higher in cirrhosis group than control group (P<0.01). Peak plasma glucose levels were obtained at 60 min in normal group and cirrhosis group. The peak insulin and C-peptide response occurred at 60 min in normal group, whereas it was delayed to 120 min in cirrhosis group. There was a significant difference between two groups in the pattern of plasma glucose levels at corresponding time points (P<0.05). The OGTT 2 h glucose and insulin levels were positively correlated with Child-Pugh Score (r1 = 0.389, r2 = 0.508, P<0.01). Conclusion: These findings implied that there was a certain degree of insulin resistance and abnormal glucose metabolism in the patients with liver cirrhosis.     

Current topics in glycemic control by wearable artificial pancreas or bedside artificial pancreas with closed-loop system

The incidence of diabetes is increasing at an unprecedented pace and has become a serious health concern worldwide during the last two decades. Despite this, adequate glycemic control using an artificial pancreas has not been established, although the 21st century has seen rapid developments in this area. Herein, we review current topics in glycemic control for both the wearable artificial pancreas for type 1 and type 2 diabetic patients and the bedside artificial pancreas for surgical diabetic patients. In type 1 diabetic patients, nocturnal hypoglycemia associated with insulin therapy remains a serious problem that could be addressed by the recent development of a wearable artificial pancreas. This smart phone-like device, comprising a real-time, continuous glucose monitoring system and insulin pump system, could potentially significantly reduce nocturnal hypoglycemia compared with conventional glycemic control. Of particular interest in this space are the recent inventions of a low-glucose suspend feature in the portable systems that automatically stops insulin delivery 2 h following a glucose sensor value <70 mg/dL and a bio-hormonal pump system consisting of insulin and glucagon pumps. Perioperative tight glycemic control using a bedside artificial pancreas with the closed-loop system has also proved safe and effective for not only avoiding hypoglycemia, but also for reducing blood glucose level variability resulting in good surgical outcomes. We hope that a more sophisticated artificial pancreas with closed-loop system will now be taken up for routine use worldwide, providing enormous relief for patients suffering from uncontrolled hyperglycemia, hypoglycemia, and/or variability in blood glucose concentrations.     

The effect of asymptomatic nocturnal hypoglycemia on glycemic control in diabetes mellitus

To assess the effect of asymptomatic nocturnal hypoglycemia on glycemic control in insulin-dependent diabetes mellitus, we studied, on three nights, 10 patients receiving their usual regimens of continuous subcutaneous insulin infusion. During a control night, the patients' mean (+/- SE) plasma glucose level reached a nadir of 4.5 +/- 0.2 mmol per liter at 3 a.m.; the fasting glucose level was 5.9 +/- 0.3 mmol per liter at 7:30 a.m., and a peak glucose level of 8.6 +/- 0.3 mmol per liter was reached at 10 a.m., after breakfast. During nights two and three, supplemental insulin was infused intravenously from 10 p.m. to 2 a.m. to simulate a clinical overdose of insulin. On these nights, either hypoglycemia (2.4 +/- 0.2 mmol per liter) was permitted to occur or a nearly normal glucose level (5.5 mmol per liter) was maintained by infusion of glucose. The subjects were asymptomatic on all three nights. Despite comparable plasma free insulin levels from 4 to 11 a.m., both fasting (7.3 +/- 0.2 mmol per liter) and postbreakfast (12.5 +/- 0.4 mmol per liter) plasma glucose levels were significantly higher after hypoglycemia than when hypoglycemia was prevented (6.2 +/- 0.2 mmol per liter and 8.7 +/- 0.4 mmol per liter, respectively; P less than 0.001 in both cases). Fasting levels of plasma glucose correlated directly with overnight plasma levels of epinephrine (r = 0.78, P less than 0.001), growth hormone (r = 0.57, P less than 0.009), and cortisol (r = 0.52, P less than 0.02) but correlated inversely with the overnight nadir of plasma glucose (r = -0.62, P less than 0.005). We conclude that asymptomatic nocturnal hypoglycemia can cause clinically important deterioration in glycemic control (the Somogyi phenomenon) in patients receiving intensive insulin therapy, and should therefore be considered in the differential diagnosis of unexplained morning hyperglycemia.     

Hypoglycemia in diabetics on dialysis with poor glycemic control: hemodialysis versus continuous ambulatory peritoneal dialysis.

Eight diabetic men with poor glycemic control, probably worsened by severe congestive heart failure and gastroparesis, were sequentially dialyzed by CAPD and hemodialysis. Mean blood glucose concentration, blood glycosylated hemoglobin, and insulin dose were higher during CAPD than during hemodialysis. Among blood glucose determinations, however, the frequency of hypoglycemia (glucose less than 3.3 mmol/L) was higher during hemodialysis (13.2 +/- 8.9%) than during CAPD (2.8 +/- 2.1% p = 0.012), whereas the frequencies of hyperglycemia (glucose greater than 11.1 mmol/L) and euglycemia (glucose between 3.5 and 11.1 mmol/l) did not differ between the two dialysis modalities. Furthermore, hypoglycemia was severe during hemodialysis and was associated with two deaths. There were no deaths linked to abnormalities in blood glucose concentration during CAPD. When hypoglycemia is frequent in diabetics with poor glycemic control, CAPD is preferable to hemodialysis.