PATIENTS WITH TYPE-1 DIABETES ADAPT ACUTELY TO SUSTAINED MILD HYPOGLYCEMIA

被引：36

作者：

KERR, D ^{[1
]}

MACDONALD, IA ^{[1
]}

TATTERSALL, RB ^{[1
]}

机构：

[1] UNIV NOTTINGHAM HOSP,QUEENS MED CTR,DEPT MED,NOTTINGHAM NG7 2UH,ENGLAND

来源：

DIABETIC MEDICINE | 1991年 / 8卷 / 02期

关键词：

COUNTERREGULATION; HYPOGLYCEMIA; CATECHOLAMINES; GLUCAGON HYPOGLYCEMIA UNAWARENESS;

D O I：

10.1111/j.1464-5491.1991.tb01557.x

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

The relationship between awareness of, and the catecholamine response to, sustained mild hypoglycaemia was examined in six well-controlled Type 1 diabetic patients (age 24-41 years, HbA1 < 10.0 %) using a hyperinsulinaemic clamp. Blood glucose was maintained at 2.8 mmol l-1 for 90 min with a euglycaemic (4.5 mmol l-1) clamp as a control. After 40 min at a blood glucose of 2.8 mmol l-1, symptom score had increased from 0.2 +/- 0.2 (+/- SE) to 3.0 +/- 0.8 (p < 0.01), cognitive function (measured by reaction time) deteriorated by 55 +/- 20 ms, and four patients 'felt hypoglycaemic'. This was associated with a rise in plasma adrenaline from 0.48 to 1.30 nmol l-1 (p < 0.01). However when hypoglycaemia was prolonged to 90 min, symptom score decreased to 1.8 +/- 0.2, none 'felt hypoglycaemic', and reaction time improved by 30 +/- 12 ms, despite a progressive rise in plasma adrenaline to 1.62 nmol l-1. Thus, despite high levels of adrenaline, diabetic patients develop reduced symptoms and no longer 'feel hypoglycaemic' during sustained mild hypoglycaemia.

引用

页码：123 / 128

页数：6

共 27 条

[21]

Herz MM, Paulson DB, Barry DI, Christiensen JS, Svendsen PA, Glucose transfer across the blood‐brain barrier, Adv Metab Dis, 10, pp. 177-192, (1983)

[22]

Clutter WE, Bier DM, Shah SD, Cryer PE, Adrenaline plasma metabolic clearance rates and physiologic thresholds for metabolic and hemodynamic actions in man, J Clin Invest, 66, pp. 94-107, (1980)

[23]

Berlin I., Grimaldi A., Bosquet F., Thorvet F., Puech A., Decreased β‐adrenergic sensitivity in insulin‐dependent diabetic subject, J Clin Endocrinol Metab, 63, pp. 262-265, (1986)

[24]

Marsden CD, Foley TH, Owen DAL, McAllister RG, Peripheral β‐adrenergic receptors concerned with tremor, Clin Sci, 33, pp. 53-65, (1967)

[25]

Fellows IW, Macdonald IA, Wharrad HJ, Birmingham AT, Low plasma concentrations of adrenaline and physiological tremor in man, J Neurol Neurosurg Psychiatry, 49, pp. 396-399, (1986)

[26]

de Feo P., Gallai V., Mazzotta G., Et al., Modest decrements in plasma glucose concentration cause early impairment in cognitive function and later activation of glucose counter‐regulation in the absence of hypoglycaemic symptoms in normal man, J Clin Invest, 82, pp. 436-444, (1988)

[27]

Blackman JD, Towle VL, Lewis GF, Spire J-P, Polonsky KS, Hypoglycaemic thresholds for cognitive dysfunction in humans, Diabetes, 39, pp. 828-835, (1990)

← 1 2 3 →