| Objective:To investigate the effect of water load on blood glucose fluctuation and gastrointestinal hormone in patients with type 2 diabetes(T2DM).Methods: T2 DM patients admitted to Dalian Central Hospital from June 2018 to December 2018 were selected for intensive insulin therapy.Dipeptidyl peptidase-4inhibitor and glucagon-like peptide-1 analogues were excluded within three months.?-glycosidase inhibitor drugs;Acute cardiovascular and cerebrovascular diseases;hepatorenal insufficiency;pregnant women;acute complications of diabetes mellitus;patients with abnormal thyroid function,and volunteered to participate in this study,a total of 11 people.The course of disease,age,height,weight,waist circumference,heart rate,systolic blood pressure,diastolic blood pressure and other general clinical data were recorded.Detection of clinical biochemical indexes,including glycosylated blood Red protein(Hb A1c),glycosylated serum protein(GSP),fasting blood glucose(FPG),2 hours postmeal blood glucose(2h PG),fasting insulin(FINS),fasting c peptide(FCP),2 hours postmeal insulin(2h INS),2 hours postmeal c peptide(2h CP),TG(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),glutamic-pyruvic transaminase(ALT),glutamic oxaloacetic transaminase(AST),etc.All the patients in the group wore Abbott Auxiliary scan glucose Monitoring system.The glucose concentration in24-hour tissue fluid was measured by lash glucose monitor,FGM),96 times in 24 hours,and the blood glucose in fingertip capillaries was measured seven times a day.In this study,the indexes of blood glucose fluctuation included the absolute value of blood glucose difference after breakfast,the peak value of blood glucose,the peak time of blood glucose reaching the peak,the amplitude of postmeal blood glucose fluctuation,and the time of 24 hours blood glucose reaching the standard.Gastrointestinal hormone indexes include glucagon-like-1(GLP-1),glucose-dependent insulin-stimulating polypeptide(GIP),growth hormone releasing peptide(Ghrelin).The experiment of fixed mixed meal for three days was carried out.the mixed meal contained carbohydrates about 22 g,protein about 20 g,fat about 25 g,and the total calorie was about 400 kcal.The patients who participated in the fixed mixed meal test had an empty stomach of at least 8 hours.The whole meal time of the fixed mixed meal test should be completed in 5 minutes.Test procedure: on the first day(eating without drinking water group): fasting GLP-1,GIP,Ghrelin,was collected at 6:00 in the morning and fixed mixed meal was performed at 7: 00 in the morning.During the meal period until 9: 00 in the morning,there is no drinking water.The next day(in-meal drinking water group): fixed mixed meal test was performed at 7: 00 in the morning.Drink 200 ml warm boiled water during meal.The third day(half an hour after meal drinking group): fixed mixed meal test was performed at 7: 00 in the morning,and200 ml warm boiled water was drank half an hour after meal(07:30).Three days at 9:00 in the morning,GLP-1,GIP,Ghrelin and synchronous 2h CP were taken at 9: 00 in the morning.Results: 1.The absolute value of blood glucose difference after breakfast in the three groups was 0.92±0.83mmol/L,1.68±1.10mmol/L,1.77±0.97 mmol/L,respectively.There was significant difference between the first group and the second group,between the first group and the third group(F value 4.563,P<0.05),but there was no significant difference between the second group and the third group(P>0.05).The peak values of blood glucose in the three groups were 8.40±1.78 mmol / L,8.96±1.28mmol/L,8.45±1.83mmol/L;blood glucose was 77.72±26.18 min,69.36±22.33 min and70.63±18.84 min,respectively.The fluctuation range of postmeal blood glucose was1.93±0.61mmol/L,2.16±1.49mmol/L,1.83±0.90mmol/L,respectively.The percentage of 24-hour blood glucose reaching the standard time was 88.16±7.94%,87.59±10.07%,85.60±5.50%,respectively.There was no significant difference between the two groups(P>0.05).2.The GIP of the three groups at 2 hours after meal was 174.86±58.56pg/ml,172.06±62.54pg/ml,190.40±61.09pg/ml,and there was significant difference between the second group and the third group(F 3.102,P<0.05).There was no significant difference between the first group and the second group,between the first group and the third group(P>0.05).The GLP-1 of the three groups at 2 hours after meal was1.58±0.58ng/ml,1.43±0.56ng/ml,1.53±0.53ng/ml,1.53±0.56ng/ml and 1.53±0.56ng/ml,respectively.The Ghrelin was 2.47±1.03ng/ml,2.40±1.15ng/ml,2.37±1.03ng/ml at 2 hours after meal,and 2.47±1.03ng/ml,2.40±1.15ng/ml and 2.37±1.03 ng /ml,respectively.The increase of GLP-1 at 2 hours after meal was 0.40±0.24ng/ml,0.25±0.37ng/ml and 0.40±0.37ng/ml,respectively,and the increase was 0.40±0.24ng/ml,0.40±0.37ng/ml and 0.40±0.37ng/ml,respectively.The increase of GIP in 2hours after meal was 37.98±18.92pg/ml,40.78±47.20pg/ml,56.31±44.64pg/ml;ghrelin increased by-0.37±0.36ng/ml,0.44±0.41ng/ml and 0.48±0.48ng/ml,respectively.there was no significant difference among the three groups(P>0.05).3.The 2h INS of the three groups were 29.05±14.45U/ml,33.98±28.51U/ml,34.98±19.73U/ml;2h CP were 1.19±0.40ng/ml,1.46±0.62ng/ml,1.49±0.78ng/ml,respectively.2h INS-FINS was 19.84±13.44U/ml,24.77±19.49U/ml,25.77±20.13U/ml;2h CP/FC was 0.11±0.39ng/ml,0.38±0.47ng/ml and 0.41±0.71ng/ml,respectively,and there was no significant difference among the three groups(P>0.05).Conclusion: 1.In patients with T2 DM,drinking water during meal and drinking water for half an hour after meal led to a significant increase in postprandial blood glucose.2.In patients with T2 DM,the secretion of GIP in drinking water after half an hour was significantly higher than that in drinking water. |
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