【摘要】 目的探讨2型糖尿病患者强化胰岛素治疗时发生夜间未察觉低血糖的情况及与睡前血糖或晚餐后血糖的关系。方法对中山大学附属第二医院内分泌科2007—2008年收治的2型糖尿病患者45例,采用强化胰岛素治疗方案,血糖达标后进行72 h动态血糖监测,分析低血糖发生情况。结果低血糖(血糖≤3.9 mmol/L)发生率为79.5%,较严重的低血糖(血糖≤2.8 mmol/L)发生率为52.3%,其中86.0%的低血糖发生在夜间,患者均无诉不适。睡前血糖与夜间低血糖发生率存在相关性(列联系数rp=0.26,P<0.05),晚餐后血糖与夜间低血糖的相关性无统计学意义(rp=0.15,P>0.05);当睡前血糖处于4.0～9.9 mmol/L时,夜间低血糖或较严重低血糖的持续时间百分比并无差异(P>0.05)。结论强化胰岛素治疗的2型糖尿病患者夜间未察觉低血糖的发生率较高;监测睡前血糖较晚餐后血糖更能反映夜间低血糖的发生;血糖4.0～9.9 mmol/L时,不主张通过刻意提高睡前血糖来降低低血糖的发生。更多还原

【Abstract】 Objective To investigate the occurrence of nocturnal hypoglycemia in type 2 diabetic patients receiving intensive insulin therapies and to study the association between asymptomatic nocturnal hypoglycemia with glucose at bedtime or after supper. Methods Forty-five type 2 diabetic inpatients were randomly divided into three groups:fifteen patients received thrice preprandial hypodermic injection of premix insulin analog,another fifteen patients received thrice preprandial insulin aspart and once insulin glargin at bedtime,and the others received thrice preprandial regular insulin and once intermediate-acting insulin at bedtime.After blood glucose reaching the treatment target,continuous glucose monitoring system was used to inspect the control of glucose and occurrence of hypoglycemia for 72 h. Results Continuous glucose monitoring system showed that the incidence of hypoglycemia(glucose no more than 3.9 mmol/L) was up to 79.5%,and 86% of them had nocturnal hypoglycemia;all patients were not aware of nocturnal hypoglycemia.The contingency coefficient of bedtime glucose with incidence of nocturnal hypoglycemia was 0.26(P<0.05).While postprandial glucose had no relation with nocturnal hypoglycemia(r=0.15,P>0.05). Conclusion Incidence of nocturnal hypoglycemia unawareness is extremely high in type 2 diabetic patients receiving intensive insulin therapies.Bedtime glucose might be a more appropriate parameter to infer nocturnal hypoglycemia than postprandial glucose.更多还原