Pernet A, Berger W
Unité de diabétologie, Hôpital de la Tour, Meyrin-Genève.
Schweiz Rundsch Med Prax. 1990 Oct 9;79(41):1237-9.
It has been reported over the last few years that transferring diabetic patients from animal to human insulin can lead, in some of the patients, to a diminution of the classical hypoglycaemic symptoms, as hunger and sweating, and to the more frequent occurrence of neuroglycopenic symptoms, as the first manifestation of hypoglycaemia. These changes seem to involve a fraction of patients estimated between 8 and 36%, depending on the type of selection of the patients. A decrease in the adrenergic counterregulatory response to hypoglycaemia has also been shown in some studies with human insulin. Similar changes in the sequence of hypoglycaemic symptoms are also described in various clinical conditions--as intensive insulin therapy with tight glycaemic control, long diabetes duration and presence of autonomic neuropathy, thus acting as confounding factors. According to these facts, a few recommendations are proposed: briefly, human insulin should only be prescribed to new patients who are able to learn from the very beginning the sequence of hypoglycaemic symptoms with human insulin; patients already treated with porcine insulin should not be transferred to human insulin. On the whole, studies available to date have not shown an increased frequency of severe hypoglycaemia with human insulin; however, this important matter still has to be conclusively clarified through well-designed prospective studies.
在过去几年中已有报道称，将糖尿病患者从动物胰岛素转换为人类胰岛素，在部分患者中可能会导致经典低血糖症状（如饥饿和出汗）减轻，而神经低血糖症状（作为低血糖的首发表现）更频繁出现。这些变化似乎涉及一部分患者，根据患者的选择类型，这部分患者比例估计在8%至36%之间。一些关于人类胰岛素的研究还表明，低血糖时肾上腺素能对抗调节反应会降低。在各种临床情况下，如强化胰岛素治疗且血糖控制严格、糖尿病病程长以及存在自主神经病变等，也描述了低血糖症状顺序的类似变化，这些情况因此成为混杂因素。基于这些事实，提出了一些建议：简而言之，人类胰岛素仅应处方给能够从一开始就了解人类胰岛素低血糖症状顺序的新患者；已经接受猪胰岛素治疗的患者不应转换为人类胰岛素。总体而言，迄今为止的研究尚未表明使用人类胰岛素会增加严重低血糖的发生率；然而，这一重要问题仍需通过精心设计的前瞻性研究最终明确。
