McCrimmon R J, Frier B M
Department of Diabetes, Royal Infirmary of Edinburgh NHS Trust, Scotland.
Diabet Med. 1997 Nov;14(11):929-36. doi: 10.1002/(SICI)1096-9136(199711)14:11<929::AID-DIA477>3.0.CO;2-4.
The aim of this study was to compare the glycaemic threshold for onset of the clinically detectable sympatho-adrenal (autonomic) reaction (defined as 'R') to hypoglycaemia induced by Lispro human insulin, with that induced by human soluble insulin (HS). The hypoglycaemia symptom profile, counterregulatory hormonal responses, and cognitive performance at R were also compared. Sixteen patients with IDDM, aged 32.5 (20-45) (median (range)) years and duration of IDDM 3.0 (0.5-4.5) years participated in a randomized, double-blind study during which intravenous infusions of either Lispro or HS insulin (2.0 mU kg(-1) min(-1)) were used on separate occasions to lower the blood glucose to the level at which R was induced. For both HS and Lispro, significant increments in systolic blood pressure (p<0.05), heart rate (p<0.05), and in autonomic (p<0.05) and neuroglycopenic symptom scores (p<0.05) occurred at R, and a significant deterioration was observed in cognitive performance (p<0.05). In response to hypoglycaemia, a significant increase from baseline occurred in plasma concentrations of all of the counterregulatory hormones (p<0.01) and the magnitude of response and temporal pattern did not differ, nor were any significant differences apparent between HS and Lispro insulins for any of the variables studied. The autonomic reaction occurred at a blood glucose (mean +/- SD) of 2.0 (+/- 0.6) mmol(-1) for Lispro and 1.9 (+/- 0.6) mmol(-1) for HS, which did not differ significantly. Thus, at the autonomic reaction to hypoglycaemia no significant differences were evident in the glycaemic threshold, symptom profile, physiological responses, and counterregulatory hormonal responses between Lispro and human soluble insulin in IDDM patients.
本研究的目的是比较赖脯人胰岛素与普通胰岛素（HS）诱发低血糖时，临床可检测到的交感-肾上腺（自主神经）反应（定义为“R”）的血糖阈值。同时还比较了在反应“R”时的低血糖症状谱、反调节激素反应及认知功能。16例胰岛素依赖型糖尿病（IDDM）患者，年龄32.5（20 - 45）岁（中位数（范围）），IDDM病程3.0（0.5 - 4.5）年，参与了一项随机双盲研究，研究期间分别在不同时间静脉输注赖脯胰岛素或普通胰岛素（2.0 mU kg⁻¹ min⁻¹），以使血糖降至诱发反应“R”的水平。对于普通胰岛素和赖脯胰岛素，在反应“R”时收缩压（p<0.05）、心率（p<0.05）、自主神经症状评分（p<0.05）和神经低血糖症状评分（p<0.05）均显著增加，且认知功能显著恶化（p<0.05）。低血糖反应时，所有反调节激素的血浆浓度均较基线显著升高（p<0.01），反应幅度和时间模式无差异，且在研究的任何变量上，普通胰岛素和赖脯胰岛素之间均无显著差异。赖脯胰岛素诱发自主神经反应时的血糖水平（均值±标准差）为2.0（±0.6）mmol⁻¹，普通胰岛素为1.9（±0.6）mmol⁻¹，两者无显著差异。因此，在IDDM患者中，赖脯胰岛素和普通胰岛素在低血糖自主神经反应时，血糖阈值、症状谱、生理反应及反调节激素反应均无显著差异。
