RESTORATION OF HYPOGLYCEMIA AWARENESS IN PATIENTS WITH LONG-DURATION INSULIN-DEPENDENT DIABETES
RESTORATION OF HYPOGLYCEMIA AWARENESS IN PATIENTS WITH LONG-DURATION INSULIN-DEPENDENT DIABETES
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DOI：
10.1016/s0140-6736(94)91336-6
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发表时间：
1994-07-30
期刊：
影响因子：
168.9
通讯作者：
AMIEL, SA
中科院分区：
文献类型：
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作者：
CRANSTON, I;LOMAS, J;AMIEL, SA
无先兆的低血糖是胰岛素依赖型糖尿病的一种危险并发症，它限制了强化胰岛素治疗以减少慢性糖尿病并发症的使用。症状性的，认知性的，在病程较长的胰岛素依赖型糖尿病患者中研究了对控制性低血糖的激素反应（6例血糖控制良好，6例血糖控制不良）。在研究开始时，所有受试者均丧失了低血糖意识。对初始激发的反应较小（汇总肾上腺素曲线下面积[AUC]为5.75 [SE 0.07] nmol/L/260 min，汇总AUC症状评分为80 [1.3]），并且仅在血糖显著低于认知功能恶化的2.8（0.1）mmol/L时开始。在4.1（1.1）个月的短期低血糖避免后，对挑战的激素和症状反应增加（AUC肾上腺素15.9 [0.1] nmol/L/260 min，p = 0.01; AUC症状评分275 [7]，p < 0.001），从血糖浓度显著高于引起认知功能障碍的血糖浓度开始。糖化血红蛋白没有显着恶化。我们的结论是，在低血糖期间认知功能障碍之前，可以通过避免低血糖来恢复正常的主观意识层次。这与疾病持续时间或初始代谢控制无关。
Hypoglycaemia without warning is a dangerous complication of insulin-dependent diabetes mellitus and it limits the use of intensified insulin therapy to reduce chronic diabetic complications.To investigate the possibility of restoring awareness; symptomatic, cognitive, and hormonal responses to controlled hypoglycaemia were studied in insulin-dependent diabetic patients with long disease duration (6 with good glycaemic control and 6 with poor control) before and after hypoglycaemia avoidance. At the start of the study, all had loss of hypoglycaemia awareness. Responses to the initial challenge were small (pooled area under curve [AUC] adrenaline 5.75 [SE 0.07] nmol/L per 260 min, pooled AUC symptom score 80 [1.3]) and only started when plasma glucose was significantly lower than the 2.8 (0.1) mmol/L at which cognitive function deteriorated. After 4.1 (1.1) months' scrupulous hypoglycaemia avoidance, hormone and symptom responses to the challenge were increased (AUC adrenaline 15.9 [0.1] nmol/L per 260 min, p = 0.01; AUC symptom score 275 [7], p < 0.001), starting at plasma glucose concentrations significantly higher than that causing cognitive dysfunction. Glycosylated haemoglobin did not deteriorate significantly.We conclude that the normal hierarchy of subjective awareness before cognitive dysfunction during hypoglycaemia can be restored by avoiding hypoglycaemia. This is independent of disease duration or initial metabolic control.