Berlin I, Grimaldi A, Payan C, Sachon C, Bosquet F, Thervet F, Puech A J
Department of Clinical Pharmacology, Hôpital Pitié-Salpêrière, Paris, France.
Diabetes Care. 1987 Nov-Dec;10(6):742-7. doi: 10.2337/diacare.10.6.742.
Thirty-seven insulin-dependent diabetic patients were tested for symptoms of hypoglycemia, cardiac autonomic neuropathy (i.e., heart rate variation during deep breathing, Valsalva maneuver, immediate heart rate response to standing), and isoproterenol sensitivity (defined as the dose of isoproterenol required to increase heart rate by 25 beats/min: I25). Tests of cardiac autonomic neuropathy showed no relation to hypoglycemic symptoms. On the contrary, a clear relationship could be established between isoproterenol sensitivity and adrenergic symptoms of hypoglycemia. Diabetic patients with decreased response to isoproterenol had fewer adrenergic symptoms, perceived hypoglycemia at a lower blood glucose level, and had more hypoglycemic accidents. Symptoms most related to isoproterenol sensitivity were tremor, sweaty palms, and hunger. With the isoproterenol-sensitivity test a distinction could be made between the groups at high (I25 greater than 3 micrograms) and low (I25 less than 3 micrograms) risk for hypoglycemic accidents. We suggest that the isoproterenol-sensitivity test could be used to identify diabetic patients at increased risk for hypoglycemia.
对37名胰岛素依赖型糖尿病患者进行了低血糖症状、心脏自主神经病变（即深呼吸、瓦尔萨尔瓦动作、站立后即刻心率反应时的心率变化）和异丙肾上腺素敏感性（定义为使心率增加25次/分钟所需的异丙肾上腺素剂量：I25）的测试。心脏自主神经病变测试显示与低血糖症状无关。相反，异丙肾上腺素敏感性与低血糖的肾上腺素能症状之间可以建立明确的关系。对异丙肾上腺素反应降低的糖尿病患者肾上腺素能症状较少，在较低血糖水平时感知到低血糖，且低血糖事故更多。与异丙肾上腺素敏感性最相关的症状是震颤、手掌出汗和饥饿。通过异丙肾上腺素敏感性测试，可以区分低血糖事故高风险组（I25大于3微克）和低风险组（I25小于3微克）。我们建议异丙肾上腺素敏感性测试可用于识别低血糖风险增加的糖尿病患者。
