Lacherade Jean-Claude, Jacqueminet Sophie, Preiser Jean-Charles
Medico-surgical ICU, Poissy Saint-Germain Hospital, Poissy, France.
J Diabetes Sci Technol. 2009 Nov 1;3(6):1242-9. doi: 10.1177/193229680900300603.
Hypoglycemia is a common and serious problem among patients with diabetes mellitus. It is also perceived as the most important obstacle to tight glucose control using intensive insulin therapy in critically ill patients. Because glucose is an obligatory metabolic fuel for the brain, hypoglycemia always represents an emergency that signals the inability of the brain to meet its energy needs. When left untreated, hypoglycemia can result in permanent brain damage and ultimately, death. In the context of critical illness that limits endogenous glucose production and increases glucose utilization, inadequate nutrition, or insufficient provision of glucose, intensive insulin therapy is the most frequent cause of hypoglycemia. Neurogenic and neuroglycopenic symptoms of hypoglycemia can remain unknown because of the underlying critical illness and sedation. Thus, close and reliable monitoring of the glycemic level is crucial in detecting hypoglycemia. In prospective randomized controlled studies comparing the effects of two glucose regimens, intensive insulin therapy aimed to reach strict glucose control (<110 mg/dl) but increased the incidence of severe hypoglycemia (<40 mg/dl) by four- to sixfold. Severe hypoglycemia is statistically associated with adverse outcomes in intensive care unit patients, although a direct causal relationship has not been demonstrated.
低血糖是糖尿病患者中常见且严重的问题。它也被视为危重症患者采用强化胰岛素治疗进行严格血糖控制的最重要障碍。由于葡萄糖是大脑必需的代谢燃料，低血糖始终代表一种紧急情况，表明大脑无法满足其能量需求。若不进行治疗，低血糖可导致永久性脑损伤，最终导致死亡。在限制内源性葡萄糖生成并增加葡萄糖利用、营养不足或葡萄糖供应不足的危重症情况下，强化胰岛素治疗是低血糖最常见的原因。由于存在潜在的危重症和镇静作用，低血糖的神经源性和神经低血糖症状可能不为人知。因此，密切且可靠地监测血糖水平对于检测低血糖至关重要。在比较两种血糖管理方案效果的前瞻性随机对照研究中，旨在实现严格血糖控制（<110 mg/dl）的强化胰岛素治疗使严重低血糖（<40 mg/dl）的发生率增加了四至六倍。尽管尚未证实存在直接因果关系，但严重低血糖在统计学上与重症监护病房患者的不良结局相关。
