Saleh T Y, Cryer P E
Division of Endocrinology, Diabetes and Metabolism, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Diabetes Care. 1997 Aug;20(8):1231-6. doi: 10.2337/diacare.20.8.1231.
To test the hypothesis that because of sustained glycemic actions, bedtime administration of the glucagon-releasing amino acid alanine or the epinephrine-simulating beta2-adrenergic agonist terbutaline more effectively prevents nocturnal hypoglycemia than a conventional bedtime snack, we studied 15 patients with IDDM.
On each of four occasions, the same individualized dose of NPH insulin (0.1-0.2 U/kg) was administered with either no treatment (control) or, in random sequence, oral treatment with a snack (240 ml of 2% milk plus one slice of toast, approximately 200 kcal), alanine (40 g, plus 10 g of glucose, approximately 200 kcal), or terbutaline (5.0 mg) at 2200.
During the first half of the night (2315-0300), mean plasma glucose concentrations were higher after the snack (P < 0.02), alanine plus glucose (P < 0.01), or terbutaline (P < 0.001), compared with no treatment. During the second half of the night, mean plasma glucose levels were no different from control values (73 +/- 5 mg/dl, 4.1 +/- 0.3 mmol/l) after the snack (73 +/- 7 mg/dl, 4.1 +/- 0.4 mmol/l), tended to be higher after alanine plus glucose (96 +/- 16 mg/dl, 5.3 +/- 0.9 mmol/l), and were significantly higher after terbutaline (124 +/- 15 mg/dl, 6.9 +/- 0.8 mmol/l, P < 0.01). Nocturnal plasma glucose levels of 40 mg/dl (2.2 mmol/l) or less (which were treated with intravenous glucose) occurred on 13 occasions in seven patients in the control arm and 10 occasions in six patients in the snack arm (not significantly different from the control arm), but on only 1 occasion in the alanine-plus-glucose arm (P < 0.02) and the terbutaline arm (P < 0.02).
In patients with IDDM given an evening dose of NPH insulin, a conventional bedtime snack exerts an inconsistent glycemic effect only during the first half of the night, and bedtime administration of the glucagon-releasing amino acid alanine or the epinephrine-simulating beta2-adrenergic agonist terbutaline more effectively prevents nocturnal hypoglycemia than a conventional bedtime snack.
为验证以下假设，即由于具有持续的血糖作用，睡前给予可释放胰高血糖素的氨基酸丙氨酸或模拟肾上腺素的β2-肾上腺素能激动剂特布他林比传统睡前小吃更有效地预防夜间低血糖，我们对15例胰岛素依赖型糖尿病（IDDM）患者进行了研究。
在四个不同的时间段，均给予相同个体化剂量的中效胰岛素（NPH胰岛素，0.1 - 0.2 U/kg），分别为不进行任何治疗（对照），或随机顺序在22:00给予口服治疗，即一份小吃（240 ml 2%的牛奶加一片面包，约200千卡热量）、丙氨酸（40克加10克葡萄糖，约200千卡热量）或特布他林（5.0毫克）。
在前半夜（23:15至03:00），与未治疗相比，小吃组（P < 0.02）、丙氨酸加葡萄糖组（P < 0.01）和特布他林组（P < 0.001）的平均血浆葡萄糖浓度更高。在后半夜，小吃组后的平均血浆葡萄糖水平与对照值（73 ± 5毫克/分升，4.1 ± 0.3毫摩尔/升）无差异（73 ± 7毫克/分升，4.1 ± 0.4毫摩尔/升），丙氨酸加葡萄糖组后倾向于更高（96 ± 16毫克/分升，5.3 ± 0.9毫摩尔/升），特布他林组后显著更高（124 ± 15毫克/分升，6.9 ± 0.8毫摩尔/升，P < 0.01）。夜间血浆葡萄糖水平低于40毫克/分升（2.2毫摩尔/升）（通过静脉输注葡萄糖治疗）在对照组的7例患者中出现13次，小吃组的6例患者中出现10次（与对照组无显著差异），但在丙氨酸加葡萄糖组和特布他林组仅各出现1次（P < 0.02）。
对于晚间给予中效胰岛素的胰岛素依赖型糖尿病患者，传统睡前小吃仅在前半夜发挥不稳定的血糖作用，而睡前给予可释放胰高血糖素的氨基酸丙氨酸或模拟肾上腺素的β2-肾上腺素能激动剂特布他林比传统睡前小吃更有效地预防夜间低血糖。
