Bernbaum M, Albert S G, Cohen J D
Department of Internal Medicine, St. Louis University School of Medicine, MO.
Arch Phys Med Rehabil. 1989 Aug;70(8):605-11.
Limited guidelines exist for rehabilitation programs for individuals with diabetes mellitus, blindness, and associated autonomic neuropathy. Abnormalities in autonomic function have been postulated to interfere with exercise conditioning and may predispose individuals to exercise-induced hypoglycemia. Twenty-nine individuals with diabetes mellitus underwent standardized noninvasive testing for the evaluation of cardiovascular autonomic function and graded exercise before entering a rehabilitation program. Inadequate responses of heart rate to respiratory variation were observed in 28 patients, abnormal heart rate responses to postural maneuvers were seen in 23, and postural hypotension was noted in nine. Individuals with symptomatic postural hypotension were able to exercise using a stationary bicycle, but developed hypotensive episodes on walking or prolonged standing. Blood glucose consistently decreased by a mean of 76 (+/- 9) mg/dl after each exercise session, even though low levels of exercise were performed (2.9 +/- 0.2 metabolic equivalents, for 28 +/- 1 min). There was no relationship between the degree of autonomic neuropathy and the level of blood glucose fall. There was, however, a significant correlation (r = -0.59, p = 0.001) between the decrease in blood glucose level and the amount of regular insulin used in the routine morning dose. Precautions were taken to avoid hypoglycemia, and insulin and diet were adjusted accordingly to prevent severe hypoglycemic reactions.
针对患有糖尿病、失明及相关自主神经病变的个体，康复项目的指导方针有限。自主神经功能异常被认为会干扰运动调节，可能使个体易发生运动诱发的低血糖。29名糖尿病患者在进入康复项目前，接受了用于评估心血管自主神经功能的标准化无创检测和分级运动测试。28例患者观察到心率对呼吸变化反应不足，23例出现心率对体位变动反应异常，9例出现体位性低血压。有症状性体位性低血压的个体能够使用固定自行车锻炼，但在行走或长时间站立时会出现低血压发作。尽管运动量较小（2.9±0.2代谢当量，持续28±1分钟），每次运动后血糖仍持续平均下降76（±9）mg/dl。自主神经病变程度与血糖下降水平之间无关联。然而，血糖水平下降与常规晨起剂量中使用的常规胰岛素量之间存在显著相关性（r = -0.59，p = 0.001）。采取了预防措施以避免低血糖，并相应调整胰岛素和饮食以防止严重低血糖反应。
