Pimazoni Augusto
Medical Coordinator of the Diabetes Education and Control Groups at the Kidney and Hypertension Hospital, Federal University of São Paulo, and at the Diabetes Center, Oswaldo Cruz German Hospital, Sao Paulo, Brazil.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.09.2008.0994. Epub 2009 Apr 17.
This case involves a 43-year-old female patient with highly uncontrolled type 2 diabetes for the past 14 years. Her weekly mean (SD) glycaemia (WMG) concentration at week 1 was 20.9 (4.8) mmol/l (377 (87) mg/dl). Four weeks after reaching full control at week 3 with insulin glargine plus regular insulin and metformin (WMG 7.0 (1.9) mmol/l (127 (34) mg/dl)) she was diagnosed with acute pulmonary tuberculosis and treated with rifampicin, isoniazid and pyrazinamide, which caused her to lose glycaemic control (WMG 21.0 (7.1) mmol/l (378 (128) mg/dl)). No other potentially hyperglycaemic drug such as corticosteroid was used. During this entire period she was intensively treated with NPH (neutral protamine Hagedorn) and regular insulins, reaching a total daily dose of 170 IU, but with no clinical response. Together with insulin therapy, rosiglitazone was started at week 12 and glycaemic control returned to normal within just 3 weeks (WMG 6.6 (2.9) mmol/l (120 (53) mg/dl)).
该病例涉及一名43岁女性患者，其2型糖尿病在过去14年中一直处于高度失控状态。第1周时她的每周平均（标准差）血糖（WMG）浓度为20.9（4.8）mmol/L（377（87）mg/dl）。在第3周使用甘精胰岛素加常规胰岛素和二甲双胍达到完全控制（WMG 7.0（1.9）mmol/L（127（34）mg/dl））四周后，她被诊断为急性肺结核，并接受利福平、异烟肼和吡嗪酰胺治疗，这导致她失去血糖控制（WMG 21.0（7.1）mmol/L（378（128）mg/dl））。未使用其他潜在的高血糖药物，如皮质类固醇。在整个期间，她接受了精蛋白锌胰岛素（NPH）和常规胰岛素的强化治疗，每日总剂量达到170 IU，但无临床反应。在胰岛素治疗的同时，第12周开始使用罗格列酮，仅3周内血糖控制就恢复正常（WMG 6.6（2.9）mmol/L（120（53）mg/dl））。
