Polonsky K, Bergenstal R, Pons G, Schneider M, Jaspan J, Rubenstein A
N Engl J Med. 1982 Oct 28;307(18):1106-12. doi: 10.1056/NEJM198210283071802.
We compared counterregulatory metabolic and hormonal responses in 8 normal controls with responses in 16 Type I (insulin-dependent) diabetics, 7 of whom had had repeated attacks of severe hypoglycemia, in an effort to determine whether these responses are related to the occurrence of hypoglycemia in the latter group. In response to insulin-induced hypoglycemia, peak values for glucose production (5.7 +/- 0.5 vs. 2.5 +/- 0.3 mg per kilogram of body weight per minute) (P less than 0.0001), glucagon (195 +/- 26 vs. 93 +/- 18 pg per milliliter) (P less than 0.0001), and growth hormone (63 +/- 8 vs. 37 +/- 5 ng per milliliter) (P less than 0.006) were significantly higher in the controls than in the diabetics. However, peak values for glucose production, glucagon, epinephrine, norepinephrine, cortisol, and growth hormone were similar in the diabetics with and without clinical hypoglycemia. Thus, with the present dose and method of insulin administration we were unable to predict the presence of severe hypoglycemic reactions in a group of Type I diabetics. Although deficient counterregulatory hormone responses are important in the pathogenesis of hypoglycemic reactions, we conclude that other factors in the daily lives of such patients also play a major part in determining whether reactions will occur.
我们比较了8名正常对照者与16名I型（胰岛素依赖型）糖尿病患者的对抗调节代谢和激素反应，其中7名糖尿病患者曾多次发生严重低血糖，目的是确定这些反应是否与后一组患者低血糖的发生有关。在胰岛素诱导的低血糖反应中，对照组的葡萄糖生成峰值（5.7±0.5对2.5±0.3毫克/千克体重/分钟）（P<0.0001）、胰高血糖素（195±26对93±18皮克/毫升）（P<0.0001）和生长激素（63±8对37±5纳克/毫升）（P<0.006）显著高于糖尿病患者。然而，有临床低血糖和无临床低血糖的糖尿病患者的葡萄糖生成、胰高血糖素、肾上腺素、去甲肾上腺素、皮质醇和生长激素的峰值相似。因此，采用目前的胰岛素给药剂量和方法，我们无法预测一组I型糖尿病患者中严重低血糖反应的存在。虽然对抗调节激素反应不足在低血糖反应的发病机制中很重要，但我们得出结论，此类患者日常生活中的其他因素在决定是否会发生反应方面也起主要作用。
