Gale E A, Tattersall R B
Lancet. 1979 May 19;1(8125):1049-52. doi: 10.1016/s0140-6736(79)92950-7.
Overnight metabolic studies in 39 poorly controlled insulin-treated diabetic patients aged 9 to 66 years showed hypoglycaemia (blood-glucose less than 2 mmol/1) in 22 patients; it lasted 3 h or more in 17. Hypoglycaemic symptoms were very mild or absent, but 19 patients had other features of overtreatment with insulin. These included lethargy, depression, night sweats, morning headaches, fits (3 patients), glycogen-laden hepatomegaly (3), and acquired tolerance to high doses of insulin (mean 1 u/kg/24 h). The best clinical clue to recurrent nocturnal hypoglycaemia was the intermittent occurrence of symptoms, however "mild" and infrequent these appeared to be. Reduction of insulin by a mean of 25% in these patients (without change of species) did not result in loss of overall control; 1 patient with recurrent ketoacidosis was stablished on 40% of his initial dose. It is difficult, sometimes impossible, to achieve good overnight control with conventional once or twice daily insulin therapy. Since patients readily become tolerant of low blood-glucose levels, reliance on urine tests and symptoms of hypoglycaemia as a guide to dosage easily produces a spiral of overtreatment.
对39名年龄在9岁至66岁之间、胰岛素治疗控制不佳的糖尿病患者进行的夜间代谢研究显示，22名患者出现低血糖（血糖低于2 mmol/L）；其中17名患者低血糖持续3小时或更长时间。低血糖症状非常轻微或没有症状，但19名患者有胰岛素过度治疗的其他特征。这些特征包括嗜睡、抑郁、盗汗、晨起头痛、癫痫发作（3例）、糖原性肝肿大（3例）以及对高剂量胰岛素产生获得性耐受性（平均1 u/kg/24 h）。反复夜间低血糖的最佳临床线索是症状的间歇性出现，无论这些症状看起来多么“轻微”和不频繁。这些患者平均减少25%的胰岛素用量（不更换胰岛素种类）并未导致整体控制的丧失；1例反复发生酮症酸中毒的患者在初始剂量的40%时病情稳定。采用传统的每日一次或两次胰岛素治疗，很难有时甚至不可能实现良好的夜间血糖控制。由于患者很容易对低血糖水平产生耐受性，依靠尿糖检测和低血糖症状来指导胰岛素剂量很容易导致过度治疗的恶性循环。
