如何判断患者存在胰岛素抵抗 李华 徐州矿务集团总医院

如何判断患者存在胰岛素抵抗 李华 徐州矿务集团总医院
第一，空腹和餐后2小时血糖的测定：测定空腹和餐后2小时血糖和胰岛素水平，可以粗略的估计有无胰岛素抵抗。如果胰岛素水平不低同时存在高血糖，即可以粗略判断存在胰岛素抵抗；如果空腹胰岛素大于15毫单位每升和2小时胰岛素水平80毫单位每升，一般就可认为胰岛素抵抗。第二，胰岛素抑制试验：早晨空腹状态，两肘静脉各维持一个通路。先用肾上腺素加普萘洛尔抑制β细胞分泌胰岛素。一路输注葡萄糖每分钟6毫克千克体重，另外一路输注胰岛素使血浆胰岛素质水平达到100微单位毫升，计算血糖浓度比胰岛素浓度比值。正常人血糖基础水平为100毫克每分升，胰岛素水平为100毫克每分升，对胰岛素抵抗的患者，胰岛素水平仍为100毫克每毫升，而葡萄糖水平责升高。第三，正常血糖葡萄糖钳夹试验，其方法是一路静脉输注胰岛素，使胰岛素水平接近100微单位每毫升，另外一路滴注外源性葡萄糖维持血糖在4.48到5.04毫摩升，测定胰岛素介导葡萄糖代谢率。

How to judge the presence of insulin resistance in patients
First, Measurement of fasting and 2-hour postprandial blood glucose: determine the fasting and 2-hour postprandial blood glucose and insulin levels, It can be roughly estimated whether there is insulin resistance. If insulin levels are not low and hyperglycemia is present, That is to say, the existence of insulin resistance can be roughly judged; If fasting insulin is greater than 15mu / L and 2 hours insulin level is 80mu / L, Insulin resistance is generally considered. Secondly, Insulin inhibition test: fasting in the morning, Two cubital veins each maintain a pathway. First, adrenaline and propranolol were used to inhibit the secretion of insulin by β cells. One way glucose infusion 6 mg / min kg body weight, Another way of insulin infusion made the quality level of plasma islets reach 100 μ ml, The ratio of blood glucose concentration to insulin concentration was calculated. The basic level of blood glucose in normal people is 100 mg / dl, The insulin level is 100 mg / dl, For patients with insulin resistance, The insulin level is still 100 mg / ml, But the glucose level is increased. Third, Normal glucose glucose clamp test, The method is to infuse insulin intravenously, So that insulin levels are close to 100 micro units per milliliter, On the other hand, the blood glucose was maintained at 4.48-5.04 mmol, The glucose metabolism rate mediated by insulin was measured.