Asplin C M, Hockaday T D, Smith R F, Moore R A
Br Med J. 1980 Feb 9;280(6211):357-60. doi: 10.1136/bmj.280.6211.357.
Cortisol to creatinine ratios in overnight urine samples, urinary glucose excretion, and plasma glucose concentrations were determined in 43 diabetic inpatients. All initially had normal cortisol to creatinine ratios (less than 55 x 10(-6)) and were initially treated by increasing their long-acting insulin component. Nine patients in whom this ratio became raised then had their long-acting insulin component reduced until their fasting plasma glucose concentration was 4-7 mol/l (72-126 mg/100 ml). The 34 patients who had never had a raised ratio were treated by increasing their long-acting insulin component until their fasting plasma glucose concentration was in the range 4-7 mmol/l. All the raised cortisol to creatinine ratios were clearly separate from the other values. A mean reduction in total insulin dose of 23% and in long-acting insulin dose of 53% was achieved, abolishing presumptive nocturnal hypoglycaemia by reducing the ratio to normal and dramatically improving diabetic control. Although there was no definite evidence that the patients who had raised cortisol to creatinine ratios had suffered from nocturnal hypoglycemia, these results strongly support the view that a raised ratio indicates an otherwise unrecognised episode of this condition.
对43例糖尿病住院患者测定了过夜尿样中的皮质醇与肌酐比值、尿葡萄糖排泄量及血浆葡萄糖浓度。所有患者最初的皮质醇与肌酐比值均正常（小于55×10⁻⁶），最初通过增加长效胰岛素成分进行治疗。9例该比值升高的患者随后减少了长效胰岛素成分，直至其空腹血浆葡萄糖浓度为4 - 7 mmol/l（72 - 126 mg/100 ml）。34例比值从未升高的患者通过增加长效胰岛素成分进行治疗，直至其空腹血浆葡萄糖浓度在4 - 7 mmol/l范围内。所有升高的皮质醇与肌酐比值均明显与其他值分开。实现了总胰岛素剂量平均降低23%，长效胰岛素剂量平均降低53%，通过将比值降至正常消除了推定的夜间低血糖，并显著改善了糖尿病控制。尽管没有确凿证据表明皮质醇与肌酐比值升高的患者曾发生夜间低血糖，但这些结果有力地支持了以下观点，即比值升高表明存在未被识别的该病症发作。
