Simonson D C, Tamborlane W V, DeFronzo R A, Sherwin R S
Ann Intern Med. 1985 Aug;103(2):184-90. doi: 10.7326/0003-4819-103-2-184.
Counterregulatory hormone responses to hypoglycemia were examined in six healthy controls and in six patients with type I diabetes before and after 4 to 8 months of insulin pump treatment. The insulin clamp technique was used to provide an identical hypoglycemic stimulus (about 50 mg/dL) in each study group. Before pump treatment, the release of counterregulatory hormones (except glucagon) during the hypoglycemic period was not significantly different in diabetics from that in normal controls. However, when values before and after pump treatment in diabetics were compared, there were significant reductions in epinephrine (304 +/- 70 and 127 +/- 43 pg/mL; p less than 0.01), growth hormone (45 +/- 12 and 18 +/- 5 ng/mL; p less than 0.05), and cortisol (20 +/- 3 and 10 +/- 2 micrograms/dL; p less than 0.01) levels during hypoglycemia. Defective glucagon release during hypoglycemia in the diabetics was not corrected by pump treatment. Intensive insulin treatment of patients with type I diabetes causes a generalized reduction in counterregulatory hormone release after a moderate fall in blood glucose levels. This reduction may impair glucose counterregulation and diminish perception of hypoglycemia, thereby increasing the risk of hypoglycemic episodes.
在6名健康对照者以及6名1型糖尿病患者中，于胰岛素泵治疗4至8个月前后，对低血糖的对抗调节激素反应进行了检测。采用胰岛素钳夹技术在每个研究组中提供相同的低血糖刺激（约50mg/dL）。在泵治疗前，糖尿病患者在低血糖期间对抗调节激素（胰高血糖素除外）的释放与正常对照者相比无显著差异。然而，当比较糖尿病患者泵治疗前后的值时，低血糖期间肾上腺素（304±70和127±43pg/mL；p<0.01）、生长激素（45±12和18±5ng/mL；p<0.05）和皮质醇（20±3和10±2μg/dL；p<0.01）水平有显著降低。糖尿病患者低血糖期间胰高血糖素释放缺陷未通过泵治疗得到纠正。对1型糖尿病患者进行强化胰岛素治疗会导致血糖水平适度下降后对抗调节激素释放普遍减少。这种减少可能会损害葡萄糖对抗调节并降低对低血糖的感知，从而增加低血糖发作的风险。
