Caduff F, Vonesch H J, Klopfstein M, Berger W
Departement für Innere Medizin, Kantonsspital Basel.
Schweiz Med Wochenschr. 1989 Jan 7;119(1):9-15.
Frequency, symptomatology and risk factors for nocturnal hypoglycemia were investigated in 77 type 1 diabetics. The patients were hospitalized overnight after a normal working day and were kept on their usual insulin regimen. Nocturnal blood sugar levels less than 2.8 mmol/l were found in 25% of 77 patients. In most cases the hypoglycemic event was not noticed by the patients. Additionally, nocturnal hormonal counterregulations were investigated in 22 patients. Plasma adrenalin, noradrenalin, somatotropin, cortisol and glucagon were measured every 2 hours. Although most of the patients were asymptomatic, a significant increase in plasma adrenalin was observed during hypoglycemia episodes. On the other hand, the increase in noradrenalin and somatotropin concentration was not significant. Blood sugar levels of 5 mmol/l and lower at 22 p.m. and at 7 a.m. (as well as diabetes duration) were identified as risk factors for nocturnal hypoglycemia. Nocturnal hypoglycemia occurs irrespective of the amount of insulin injected in the evening or at bedtime. Similarly, neither the time of late insulin injection nor the degree of metabolic control as assessed by HbA1c differed in patients undergoing hypoglycemic episodes and patients without hypoglycemia.
对77例1型糖尿病患者的夜间低血糖发生频率、症状及危险因素进行了调查。患者在正常工作日后住院过夜，并维持其常规胰岛素治疗方案。77例患者中有25%出现夜间血糖水平低于2.8 mmol/l。多数情况下，患者未察觉到低血糖事件。此外，对22例患者的夜间激素对抗调节情况进行了研究。每2小时检测一次血浆肾上腺素、去甲肾上腺素、生长激素、皮质醇和胰高血糖素。尽管多数患者无症状，但在低血糖发作期间观察到血浆肾上腺素显著升高。另一方面，去甲肾上腺素和生长激素浓度的升高并不显著。晚上10点和早上7点血糖水平≤5 mmol/l（以及糖尿病病程）被确定为夜间低血糖的危险因素。夜间低血糖的发生与晚上或睡前注射胰岛素的剂量无关。同样，发生低血糖事件的患者与未发生低血糖的患者相比，晚胰岛素注射时间及糖化血红蛋白评估的代谢控制程度均无差异。
