Bending J J, Pickup J C, Collins A C, Keen H
Diabetes Care. 1985 Jan-Feb;8(1):28-33. doi: 10.2337/diacare.8.1.28.
We assessed the quality of overnight glycemic control and the frequency of the "dawn phenomenon" (nadir-0800 h glycemic increase) in 41 insulin-dependent diabetic patients treated by continuous subcutaneous insulin infusion (CSII). Mean plasma glucose levels were near-normal during the 24 h and, in particular, constant throughout the night. In a subset of six patients overnight plasma free insulin concentrations were also constant during CSII. The majority of profiles (88%) showed a glucose nadir from 2.0 to 5.9 mmol/L (most frequently at 0600 h) and had an 0800 h value from 2.0 to 6.9 mmol/L (92%). A large proportion (46%) of profiles showed a zero or negative nadir-0800 h glycemic increase. In 22 patients with three or more profiles recorded at the same basal insulin infusion rate, only one of 103 profiles had a fasting glycemic increase greater than an arbitrary value of 5.0 mmol/L (5.3), although many patients exhibited small dawn glycemic increases (e.g., 14 of 22 had a mean increase of from 0 to 2 mmol/L). In 12 subjects a 15% reduction in basal insulin infusion rate increased the mean +/- SEM dawn glycemic increase from 0.58 +/- 0.25 mmol/L to 2.7 +/- 0.76 mmol/L (P less than 0.025) as well as significantly increasing the nocturnal nadir and 0800 h plasma glucose concentrations. Thus, a marked dawn phenomenon is rare when a single but adequate basal infusion rate is used for CSII, and this questions the need in the majority of patients for preprogrammable pumps with nocturnal infusion rate changes.
我们评估了41例接受持续皮下胰岛素输注（CSII）治疗的胰岛素依赖型糖尿病患者夜间血糖控制质量及“黎明现象”（最低点至08:00时血糖升高）的发生频率。24小时内平均血浆葡萄糖水平接近正常，尤其是整个夜间保持稳定。在6例患者的亚组中，CSII期间夜间血浆游离胰岛素浓度也保持稳定。大多数血糖曲线（88%）显示血糖最低点在2.0至5.9 mmol/L之间（最常见于06:00时），08:00时血糖值在2.0至6.9 mmol/L之间（92%）。很大一部分（46%）血糖曲线显示最低点至08:00时血糖升高为零或呈负值。在22例以相同基础胰岛素输注速率记录了三条或更多血糖曲线的患者中，103条曲线中只有1条空腹血糖升高大于任意设定值5.0 mmol/L（5.3），尽管许多患者表现出较小的黎明血糖升高（例如，22例中有14例平均升高0至2 mmol/L）。在另外12例受试者中，基础胰岛素输注速率降低15%，使平均±标准误黎明血糖升高从0.58±0.25 mmol/L增至2.7±0.76 mmol/L（P<0.025），同时显著增加了夜间最低点及08:00时血浆葡萄糖浓度。因此，当CSII使用单一且合适的基础输注速率时，明显的黎明现象很少见，这对大多数患者是否需要可预设夜间输注速率变化的胰岛素泵提出了质疑。
