Reyes García R, Mezquita Raya P
Unidad de Endocrinología, Hospital General Universitario Rafael Méndez, Lorca, Murcia, España; Servicio de Endocrinología, Clínica San Pedro, Almería, España.
Unidad de Endocrinología, Nutrición y Riesgo Vascular, Complejo Hospitalario Torrecárdenas, Almería, España; Servicio de Endocrinología, Clínica San Pedro, Almería, España.
Rev Clin Esp (Barc). 2014 May;214(4):202-8. doi: 10.1016/j.rce.2013.12.011. Epub 2014 Jan 24.
A 58 year-old woman with type 2 diabetes diagnosed 3 years before came to our clinic. Her treatment was metformin 850 mg every 12 hours and glimepiride 4 mg every 24 hours. After the initiation of glimepiride 9 months before her weight has increased 5 kg, and she suffers frequent hypoglycemias which have affected her while driving. Her BMI is 35.5 kg/m². She has a normal eye fund exam. She has hypertension treated with telmisartán and hidroclorotiazide with adequate control, and also hypercholesterolemia treated with atorvastatine 40 mg every 24 hours. Her blood test shows an HbA1c of 7.0%, normal values of microalbuminuria, total cholesterol 149 mg/dl, HDL cholesterol 52 mg/dl, LDL cholesterol 98 mg/dl and triglycerides 123 mg/dl. Her blood pressure is 129/81 mmHg, there was no orthostatic hypotension, and her peripheral neurological examination shows normal results. In summary, our case is a young woman with type 2 diabetes and obesity, without chronic complications and which has frequent hypoglycaemia. How must this woman be evaluated and treated?
一名58岁女性，3年前被诊断为2型糖尿病，前来我院就诊。她的治疗方案是每12小时服用850毫克二甲双胍，每24小时服用4毫克格列美脲。在9个月前开始服用格列美脲后，她的体重增加了5公斤，并且频繁发生低血糖，这在她开车时对她造成了影响。她的体重指数（BMI）为35.5千克/平方米。她的眼底检查正常。她患有高血压，服用替米沙坦和氢氯噻嗪治疗，血压控制良好，还患有高胆固醇血症，每24小时服用40毫克阿托伐他汀治疗。她的血液检查显示糖化血红蛋白（HbA1c）为7.0%，微量白蛋白尿值正常，总胆固醇149毫克/分升，高密度脂蛋白胆固醇52毫克/分升，低密度脂蛋白胆固醇98毫克/分升，甘油三酯123毫克/分升。她的血压为129/81毫米汞柱，没有直立性低血压，并且她的周围神经检查结果正常。总之，我们的病例是一名患有2型糖尿病和肥胖症的年轻女性，没有慢性并发症，但频繁发生低血糖。该如何对这名女性进行评估和治疗？
