Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
Danish Diabetes Academy, Odense, Denmark.
Diabetes Care. 2017 Jan;40(1):132-135. doi: 10.2337/dc16-1472. Epub 2016 Oct 21.
This study compared the ability of glucagon to restore plasma glucose (PG) after mild hypoglycemia in patients with type 1 diabetes on an isocaloric high-carbohydrate diet (HCD) versus a low-carbohydrate diet (LCD).
Ten patients with insulin pump-treated type 1 diabetes randomly completed 1 week of the HCD (≥250 g/day) and 1 week of the LCD (≤50 g/day). After each week, mild hypoglycemia was induced by a subcutaneous insulin bolus in the fasting state. When PG reached 3.9 mmol/L, 100 µg glucagon was given subcutaneously, followed by 500 µg glucagon 2 h later.
Compared with the HCD, the LCD resulted in lower incremental rises in PG after the first (mean ± SEM: 1.3 ± 0.3 vs. 2.7 ± 0.4 mmol/L, P = 0.002) and second glucagon bolus (4.1 ± 0.2 vs. 5.6 ± 0.5 mmol/L, P = 0.002). No differences were observed between the diets regarding concentrations of insulin, glucagon, and triglycerides.
The LCD reduces the treatment effect of glucagon on mild hypoglycemia. Carbohydrate intake should be considered when low-dose glucagon is used to correct hypoglycemia.
本研究比较了在接受等热量高碳水化合物饮食（HCD，≥250 克/天）和低碳水化合物饮食（LCD，≤50 克/天）治疗的 1 型糖尿病患者中，胰高血糖素恢复轻度低血糖后血浆葡萄糖（PG）的能力。
10 例接受胰岛素泵治疗的 1 型糖尿病患者随机完成了 1 周的 HCD（≥250 克/天）和 1 周的 LCD（≤50 克/天）。在每一周，通过空腹状态下的皮下胰岛素推注诱导轻度低血糖。当 PG 达到 3.9mmol/L 时，皮下给予 100µg 胰高血糖素，2 小时后给予 500µg 胰高血糖素。
与 HCD 相比，LCD 导致第一次（平均±SEM：1.3±0.3 与 2.7±0.4mmol/L，P=0.002）和第二次胰高血糖素推注后 PG 的增量升高较低，第二次胰高血糖素推注后 PG 的增量升高较低（4.1±0.2 与 5.6±0.5mmol/L，P=0.002）。两种饮食之间胰岛素、胰高血糖素和甘油三酯的浓度没有差异。
LCD 降低了胰高血糖素对轻度低血糖的治疗效果。在使用低剂量胰高血糖素纠正低血糖时，应考虑碳水化合物的摄入量。
