[Sulfonylurea resistance in type II diabetes mellitus. Assessment of metabolic and hormonal aspects].
Sensitivity tests to SU allow two populations to be distinguished. One contains severely diabetic subjects in a continuous state of metabolic precariousness with reduced alkaline reserves, hyperinsulinemia and insulin resistance; the other contains mildly diabetic subjects who are normoinsulemic and show no insulin-resistance to i.v. tests irrespective of the presence of a similar level of SU resistance. While the first group may be more readily interpreted, especially with reference to the dualism between the alterations of insulin synthesis and resistance of peripheral tissues, with special reference to the function of receptors and post-receptors, the second group raises numerous questions of interpretation. The test becomes important to identify those subjects who right from the start show a reduced insulin secretion to drug stimulation and the possibility of obtaining euglycemia with high doses of SU. This finding suggests the existence of a genetically determined mechanism for SU resistance: in addition to the population who show marked SU resistance from the onset of diabetic symptoms, there is also a group of subjects in whom this resistance is less evident and may be provoked only by certain stimuli or spontaneously under stress, or by the appearance of the triggering metabolic factor. It is clearly important to identify the latter population before the clinical manifestation of symptoms so as to establish the correct therapy or combined therapy. This led us to consider the SU-resistant cases in the series of patients studied as being two clinical stages of the same condition rather than two separate populations with different pathogenesis.
Cortinovis
A
A
Cattedra di Semeiotica Medica, Dipartimento di Medicina Interna e Farmacologia Clinica, Università di Pavia.
Crippa
A
A
Romano
E
E
Crippa
M
M
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D013453:Sulfonylurea Compounds / Q000378:metabolism*
D001786:Blood Glucose; D007328:Insulin; D013453:Sulfonylurea Compounds
Resistenza alle sulfaniluree nel diabete di tipo II. Valutazione degli aspetti metabolici ed ormonali.