Boyle Patrick J, Zrebiec John
Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
South Med J. 2007 Feb;100(2):183-94. doi: 10.1097/01.smj.0000242864.17631.a2.
Iatrogenic hypoglycemia is the main factor limiting aggressive and optimal diabetes management. Rather than being an inevitable consequence of optimal glycemic control, however, hypoglycemia is avoidable and generally straightforward to manage when it occurs. Professional caregivers, patients, and their families are often fearful of hypoglycemia, even though most episodes are minor and easily self-treated. Understanding the factors contributing to hypoglycemia risk and how to minimize its occurrence is an essential part of diabetes care. Building on the physiologic fundamentals presented in the accompanying review, the incidence, mortality/morbidity, clinical symptoms, severity classification, and psychosocial impact of hypoglycemia are described here. Appropriate selection and titration of therapeutic agents, including insulin analogs with more predictable time-action profiles than human insulin formulations, can reduce hypoglycemia risk. Patient education about hypoglycemia prevention, including symptom recognition and necessity of rapid treatment, behavioral modification, and the importance of frequent blood glucose monitoring should accompany all therapeutic interventions.
医源性低血糖是限制积极且优化的糖尿病管理的主要因素。然而，低血糖并非最佳血糖控制的必然结果，它是可以避免的，并且在发生时通常易于处理。专业护理人员、患者及其家属常常惧怕低血糖，尽管大多数发作轻微且易于自我处理。了解导致低血糖风险的因素以及如何将其发生降至最低是糖尿病护理的重要组成部分。基于随附综述中阐述的生理基础，本文描述了低血糖的发生率、死亡率/发病率、临床症状、严重程度分级以及社会心理影响。合理选择和调整治疗药物，包括选择比人胰岛素制剂具有更可预测的时间作用曲线的胰岛素类似物，可降低低血糖风险。所有治疗干预措施都应伴随对患者进行低血糖预防教育，包括症状识别、快速治疗的必要性、行为改变以及频繁血糖监测的重要性。
