Vervoort G, Goldschmidt H M, van Doorn L G
Department of General Internal Medicine, University Hospital Nijmegen, The Netherlands.
Diabet Med. 1996 Sep;13(9):794-9. doi: 10.1002/(SICI)1096-9136(199609)13:9<794::AID-DIA185>3.0.CO;2-G.
The aim of the study was to examine nocturnal blood glucose profiles in Type 1 diabetic patients on multiple (> or = 4) daily insulin injections. Nocturnal blood glucose profiles were evaluated in 31 patients collecting blood samples half-hourly from 23.00 till 07.30 h, while they were asleep. Nocturnal episodes of hypoglycaemia (blood glucose < 3.0 mmol l-1 occurred in 29% of these nights; 67% of episodes were asymptomatic. In the early night (23.00-01.00 h), five episodes occurred with a median duration of 1 h. In the early morning (04.00-07.30 h) seven episodes occurred with a median duration of 3 h. No hypoglycaemia was noted from 01.00 to 04.00 h. Bedtime glucose levels appeared to predict 'early night' hypoglycaemia but not 'early morning' hypoglycaemia. Fasting glucose levels < 5.5 mmol l-1 were indicative of preceding 'early morning' hypoglycaemia. There was a large intra-individual variation in nocturnal blood glucose profiles. It is concluded that daily monitoring of bedtime and fasting blood glucose levels may be both more reliable and convenient for the prevention of nocturnal hypoglycaemia than periodic testing of blood glucose at 03.00h as is often advised. Setting a target of > 5.5 mmol l-1 for fasting blood glucose may decrease the frequency of nocturnal hypoglycaemia.
本研究的目的是检测接受多次（≥4次）每日胰岛素注射的1型糖尿病患者的夜间血糖情况。对31例患者进行了夜间血糖情况评估，他们在睡眠期间于23:00至07:30每半小时采集一次血样。这些夜晚中有29%出现夜间低血糖发作（血糖<3.0 mmol/L）；67%的发作无症状。在夜晚早期（23:00至01:00），发生了5次发作，中位持续时间为1小时。在清晨（04:00至07:30），发生了7次发作，中位持续时间为3小时。在01:00至04:00未发现低血糖。睡前血糖水平似乎可预测“夜晚早期”低血糖，但不能预测“清晨”低血糖。空腹血糖水平<5.5 mmol/L提示之前有“清晨”低血糖。夜间血糖情况存在较大的个体内差异。结论是，对于预防夜间低血糖，每日监测睡前和空腹血糖水平可能比通常建议的在03:00定期检测血糖更可靠、更方便。将空腹血糖目标设定为>5.5 mmol/L可能会降低夜间低血糖的发生率。
