Lev-Ran A
Arch Intern Med. 1978 Mar;138(3):372-6.
The brittleness of 100 severe diabetics was calculated as the mean of differences of blood glucose between two consecutive days at four time points (fasting, one and two hours after breakfast, and two hours after lunch). Mean daily difference (MDD) had a unimodal distribution; 15 patients with a MDD greater than 100 mg/100 ml were classified as most brittle. There was no correlation between MDD and insulin requirement. The brittle diabetics received 26 to 48 units of insulin/day. The insulin-resistant patients had low MDD values. No difference was found between seven patients with brittle diabetes and seven stable matched controls in insulin-binding capacity or total insulin. In two groups of six patients each with brittle diabetes, it was found that the stable dosage caused less brittleness than a sliding-scale regimen and that routine injection of 4 units of regular insulin before meals slightly decreased the mean diurnal glycemia level but increased the number of hypoglycemias. In two brittle diabetics, the blood glucose level was stabilized on intravenously administered insulin infusion, and in these patients, meals caused only a moderate hyperglycemia.
计算100名重度糖尿病患者的脆性，方法是在四个时间点（空腹、早餐后1小时和2小时、午餐后2小时）计算连续两天血糖差异的平均值。日均差异（MDD）呈单峰分布；15名MDD大于100mg/100ml的患者被归类为脆性最高的患者。MDD与胰岛素需求量之间无相关性。脆性糖尿病患者每天接受26至48单位胰岛素治疗。胰岛素抵抗患者的MDD值较低。在7名脆性糖尿病患者和7名匹配的稳定对照组患者之间，胰岛素结合能力或总胰岛素量未发现差异。在两组各有6名脆性糖尿病患者中，发现稳定剂量方案比滑动剂量方案导致的脆性更小，且餐前常规注射4单位正规胰岛素可略微降低日间平均血糖水平，但会增加低血糖发作次数。在两名脆性糖尿病患者中，静脉输注胰岛素使血糖水平稳定，在这些患者中，进餐仅引起中度高血糖。
