Department of Endocrinology, Odense University Hospital, Odense, Denmark.
Diabetes Res Clin Pract. 2012 Oct;98(1):91-7. doi: 10.1016/j.diabres.2012.04.014. Epub 2012 Jul 17.
Nocturnal hypoglycemia is a feared complication to insulin treated diabetes. Impaired awareness of hypoglycemia (IAH) increases the risk of severe hypoglycemia. EEG changes are demonstrated during daytime hypoglycemia. In this explorative study, we test the hypothesis that specific hypoglycemia-associated EEG-changes occur during sleep and are detectable in time for the patient to take action.
Ten patients with type 1 diabetes (duration 23.7 years) with IAH were exposed to insulin-induced hypoglycemia during the daytime and during sleep. EEG was recorded and analyzed real-time by an automated multi-parameter algorithm. Participants received an auditory alarm when EEG changes met a predefined threshold, and were instructed to consume a meal.
Seven out of eight participants developed hypoglycemia-associated EEG changes during daytime. During sleep, nine out of ten developed EEG changes (mean BG 2.0 mmol/l). Eight were awakened by the alarm. Four corrected hypoglycemia (mean BG 2.2 mmol/l), while four (mean BG 1.9 mmol/l) received glucose infusion. Two had false alarms. EEG-changes occurred irrespective of sleep stage. Post hoc improvement indicates the possibility of earlier detection of hypoglycemia.
Continuous EEG monitoring and automated real-time analysis may constitute a novel technique for a hypoglycemia alarm in patients with IAH.
夜间低血糖是接受胰岛素治疗的糖尿病患者所担心的一种并发症。低血糖意识受损（IAH）会增加严重低血糖的风险。在白天发生低血糖时，脑电图会发生变化。在这项探索性研究中，我们检验了以下假说，即在睡眠期间会发生特定的与低血糖相关的脑电图变化，并且可以及时检测到这些变化，以便患者采取行动。
10 名患有 1 型糖尿病（病程 23.7 年）和 IAH 的患者在白天和睡眠期间接受胰岛素诱导的低血糖。实时记录和分析 EEG，使用自动化多参数算法。当 EEG 变化达到预设阈值时，参与者会收到听觉警报，并被指示进食。
在白天，8 名参与者中有 7 名出现了与低血糖相关的 EEG 变化。在睡眠期间，10 名参与者中有 9 名出现了 EEG 变化（平均血糖 2.0mmol/l）。有 8 人被警报唤醒。其中 4 人通过进食纠正了低血糖（平均血糖 2.2mmol/l），而 4 人（平均血糖 1.9mmol/l）接受了葡萄糖输注。有 2 人出现了假警报。EEG 变化发生与睡眠阶段无关。事后改善表明，更早地检测低血糖是可能的。
连续 EEG 监测和自动化实时分析可能构成 IAH 患者低血糖警报的一种新方法。
