Higher Glycemic Thresholds for Symptoms During β-Adrenergic Blockade in IDDM
Higher Glycemic Thresholds for Symptoms During β-Adrenergic Blockade in IDDM
复制标题
IDDM β-肾上腺素能阻断期间症状的血糖阈值较高
作者：
I. Hirsch;P. Boyle;S. Craft;P. Cryer
我们测试了这样的假设，即非选择性β肾上腺素能阻断并不会导致绝对的低血糖无意识，而是将症状的血糖阈值改变为降低血糖浓度，并且低血糖期间的神经血糖生成症状和认知障碍都不会因β肾上腺素能阻断而改变。为此，我们在无β肾上腺素能拮抗剂心得安的情况下(n=8)和(n=9)对中度控制的胰岛素依赖型糖尿病(IDDM)患者应用了正血糖和阶梯式降糖钳夹技术。与相应的正常血糖钳夹相比，在没有心得安的情况下，总症状评分首先在4.4 mM的血糖步长(高于先前研究的非糖尿病受试者的2.8 mM)时增加。β-肾上腺素能受体阻滞剂并不会产生绝对的低血糖意识。事实上，坦率地说，在2.8 mm的降糖步骤中，有心得安的总症状评分往往高于没有心得安的情况。这在很大程度上是发汗(P<；0.01)感觉更强烈的结果。然而，在β肾上腺素能阻断期间，直到3.3mM的血糖阶梯，症状评分才增加。在较高的血糖水平下，心得安可以减少饥饿的感觉，或许还有颤抖的感觉。普萘洛尔不能减少神经降糖症状。记忆的认知功能，但不是注意力的认知功能，也从4.4 mM的葡萄糖阶梯开始受损。普萘洛尔不会进一步削弱这一作用。由此，我们得出了以下结论。1)非选择性β肾上腺素能受体阻滞剂不会使糖尿病患者完全意识不到低血糖，而是使症状的血糖阈值改变为降低血糖浓度。2)β-肾上腺素能受体阻滞剂不能减轻糖尿病患者的神经糖原症状，也不会进一步损害糖尿病患者低血糖时的认知功能。
We tested the hypotheses that nonselective β-adrenergic blockade does not cause absolute hypoglycemia unawareness but shifts the glycemic thresholds for symptoms to lower plasma glucose concentrations and that neither neuroglycopenic symptoms nor cognitive impairments during hypoglycemia are altered by β-adrenergic blockade. To do so, we applied the euglycemic and stepped hypoglycemic clamp techniques to patients with moderately controlled insulin-dependent diabetes mellitus (IDDM) in the absence (n = 8) and presence (n = 9) of the nonselective β-adrenergic antagonist propranolol. Compared with the corresponding euglycemic clamps, total symptom scores first increased at the 4.4-mM plasma glucose step (a higher level than that of 2.8 mM in nondiabetic subjects studied previously) in the absence of propranolol. β-adrenergic blockade did not produce absolute hypoglycemia unawareness. Indeed, at the frankly hypoglycemic step of 2.8 mM, total symptom scores tended to be higher in the presence than in the absence of propranolol. This was largely the result of greater (P < 0.01) perception of diaphoresis. However, symptom scores did not increase until the 3.3-mM plasma glucose step during β-adrenergic blockade. The perception of hunger, and perhaps that of tremulousness, was reduced by propranolol at the higher glucose steps. Neuroglycopenic symptoms were not reduced by propranolol. The cognitive function of memory, but not that of attention, was impaired, also starting at the 4.4-mM glucose step. This was not impaired further by propranolol. Thus, we formed the following conclusions. 1) Nonselective β-adrenergic blockade does not cause absolute hypoglycemia unawareness but shifts the glycemic thresholds for symptoms to lower plasma glucose concentrations in patients with IDDM. 2) β-adrenergic blockade does not reduce neuroglycopenic symptoms, and it does not further impair cognitive function during hypoglycemia in IDDM patients.
DOI：
10.1172/jci110455
发表时间：
1982-02
期刊：
The Journal of clinical investigation
影响因子：
--
作者：
Dennis A. Popp;Suresh D. Shah;P. Cryer
通讯作者：
Dennis A. Popp;Suresh D. Shah;P. Cryer
低血糖对人胰多肽分泌的刺激与肾上腺素能机制无关。
DOI：
10.1210/jcem-55-6-1234
发表时间：
1982
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
--
作者：
Rizza,R;Go,V;Cryer,P;Verdonk,C;Gerich,J
通讯作者：
Gerich,J
荷尔蒙对记忆的影响。
影响因子：
24.8
作者：
McGaugh,JL
通讯作者：
McGaugh,JL