早期护理干预控制糖尿病母亲新生儿低血糖效果观察

目的 探讨糖尿病母亲新生儿低血糖发生规律及护理干预方法，防止低血糖的发生，减少对新生儿造成不良影响。方法 将1998年9月～2002年5月新生儿病区住院的母亲有糖尿病的新生儿分为两组：母亲孕期进行严格血糖控制的新生儿为监控组：孕期未进行严格血糖控制的新生儿为未监控组，分别于生后叽2h、6h、12h、24h、48h、72h采集足跟血进行血糖监测。结 果糖尿病母亲新生儿低血糖主要发生在生后0—6h，以0～2h发生率最高：孕期进行严格血糖控制的糖尿病母亲新生儿低血糖发生率远低于未进行严格血糖控制的糖尿病母亲所生新生儿。结论 糖尿病母亲孕期严格血糖控制和新生儿出生后早期血糖监测及护理干预可有效降低新生儿低血糖的发生率。     

连续非卧床性腹膜透析治疗糖尿病肾病的护理

目的：了解经连续非卧床性腹膜透析（CAPD）治疗糖尿病肾病（DN）患的临床特点，以指导护理。方法：收集经CAPD治疗的91例DN患与非透析治疗的72例DN患资料进行分析，比较其低血糖、低血钾的发生率、发生诱因及症状。结果：CAPD治疗组低血糖、低血钾的发生率分别为39％,48％，较非透析治疗组18％，26％高（ P＜0．05）。饮食减少是CAPD治疗组发生低血糖、低血钾的主要原因，而非透析治疗组低血糖、低血钾则主要由胰岛素使用不当及腹泻引起。提示，以CAPD治疗的糖尿病肾病患低血糖、低血钾发生率、发生诱因及症状均不同于非透析 治疗组，护理时应区别对待。     

新生儿低血糖42例临床及病因分析

目的 探讨引起新生儿低血糖的危险因素及，临床特点，为诊治提供依据。方法 对存在低血糖高危因素的新生儿140例进行血糖监测。结果 检出低血糖42例，，临床症状多不典型，且无特异性，常见疾病为窒息18例（42．8％），溶血1例（2．4%），早产儿及小于胎龄儿13例（31％），感染3例（7．1％），母亲患糖尿病1例（2．4%），喂养困难6例（14．3％）。结论 对于有低血糖高危因素的新生儿要监测血糖，及时发现，及时纠正，避免低血糖引起中枢神经系统损伤。     

Quantitative monitoring of brain function,vital signs,and hormonal response during acute insulin-induced hypoglycemia

Acute insulin-induced hypoglycemia provokes changes in central nervous system activity and release of counterregulatory hormones. The clinical relationship between central nervous system activity, hormone secretion, and vital signs has not to our knowledge been previously reported. We used computerized electroencephalographic (CEEG) analysis to monitor 5 nondiabetic subjects during acute insulin-induced hypoglycemia (0.75 U/kg intravenous push). Their glucose nadir was 38±6 mg/dl (mean ± 1 SD). A three-phase pattern of change in CEEG power in response to hypoglycemia was observed: phase 1 was characterized by an increase in total CEEG power (natural log of activity = 9.1±1.3 µV²) over baseline (8.7±1.2 µV²) in the theta, delta, and beta frequency bands. This phase preceded and coincided with the glucose nadir. During phase 2, power in all frequency bands fell significantly below baseline. A nadir in CEEG power (8.0±1.6 µV²) occurred 40 to 55 minutes after insulin injection as glucose levels were rising. During phase 3 there was a return to baseline in CEEG power and frequency spectra. Heart rate increase just before phase 1; peak heart rate (91±8 beats/min) coincided with peak CEEG power and was significantly higher than basal rate (71±11,P<0.05). A significant increase in respiratory rate occurred during phase 1 of the CEEG and persisted through phase 2. A significant decrease in mean blood pressure (nadir = 73±6 mm Hg) below preinsulin blood pressure (81±8 mm Hg,P<0.05) coincided with the nadir of CEEG power in phase 2. Blood pressure returned to basal levels during phase 3. Peak plasma epinephrine (652±207 versus 46±30 pg/ml), norepinephrine (500±219 versus 273±107 pg/ml), and pancreatic polypeptide levels (1,023±689 versus 114±24 pg/ml) were all significantly elevated over respective basal concentrations (P<0.05). Peak hormone levels occurred during CEEG phase 2. This study demonstrates a temporal association of changes in CEEG power, vital signs, and hormonal secretion. These techniques may be applicable for further investigation of the clinical neuroendocrinology of the response to acute hypoglycemia.Supported in part by the Diabetes Research and Education Fund and the Juvenile Diabetes Foundation.The authors thank Diane Ogorzalek and Patsy Thomas for secretarial assistance and Pediatric Endocrine Unit nurses Debra Pitarra and Joyce Hylton. Baiba Pironis performed the catecholamine assays. Specific reagents for the human pancreatic polypeptide assay were provided through the courtesy of Dr Ronald Chance, Lilly, Indianapolis, IN. Presented in part at the 70th Annual Meeting of the Endocrine Society, New Orleans, June 1988, and at the Annual Meeting of the American Society of Anesthesiology, San Francisco, October 1988.     

Effect of 50 Milliliters of 50% Dextrose in Water Administration on the Blood Sugar of Euglycemic Volunteers

Abstract. Objective : To evaluate the effect of administration of 1 ampule of 50% dextrose in water solution (D₅₀W) on serum glucose levels in healthy adult volunteers, the authors set out to determine whether a pre-D₆₀W serum glucose level can be predicted from the ED sample. Methods : This was a prospective, interventional study conducted from the ED of an urban, university-affiliated hospital. All subjects were healthy employee volunteers between 25 and 40 years of age. Baseline serum glucose levels were determined and all subjects were given an IV bolus of 25 grams of 50% dextrose solution. The main outcome measures were post-D₅₀W serum glucose levels (observed) at 5 predetermined time intervals (5 min, 15 min, 30 min, 1 hr, and 2 hr). An expected change in serum glucose was calculated using the volume of distribution formula for glucose. Results : Twenty-five volunteers (17 males and 8 females) participated in the study. The mean baseline serum glucose was 82.3 ± 13.5 mg/dL. The mean post-infusion levels were: 244.4 ± 44.6 mg/dL (5 min), 145.8 ± 52.3 mg/dL (15 min), 88.1 ± 28.8 mg/dL (30 min), 77.6 ± 13.6 mg/dL (60 min), and 83.2 ± 11.4 mg/dL (120 min). Using a mixed-effect regression model, statistically significant increases in serum glucose levels were found at 5 minutes (p < 0.001) and 15 minutes (p < 00001) following administration of D₅₀W. There was a return to baseline serum glucose by 30 minutes. The expected change based on the volume of distribution formula (53.7 ± 34.9) did not correlate with the observed changes at any measured time interval. Conclusion : Without pre-intervention blood drawing by emergency medical services, it is not possible to accurately predict pre-D₅₀W serum glucose levels based on post-D₅₀W glucose levels. The diagnosis of hypoglycemia as the etiology of altered mental status must therefore remain a diagnosis of exclusion. In addition, the return of serum glucose to baseline after 30 minutes suggests the duration of the effect of 1 ampule of D₅₀W. Frequent re-evaluation of the serum glucose levels of suspected or proven hypoglycemic patients after administration of D₅₀W should be considered.     

Postmarketing study of nateglinide in Japan: treatment of medication-naïve patients with type 2 diabetes

Nateglinide is an oral antidiabetic medication (OAD) that acts through rapid, short-term stimulation of insulin production. This study was conducted to identify the nature of any adverse effects associated with nateglinide and to evaluate its clinical efficacy in patients with type 2 diabetes, with particular attention to hypoglycemia. Patients with type 2 diabetes who were OAD naïve (n=547), whose fasting blood glucose levels were 150 mg/dL or lower, and who had started to take nateglinide alone were recruited from 139 centers in Japan with a 12-week observation period. The incidence of adverse reactions was 7.62%. Hypoglycemia accompanied by hypoglycemic symptoms was the most prevalent adverse event (2.10%; 11/525). Nine of 11 episodes required no therapeutic intervention. Severe hypoglycemia was recognized in only 1 case of diabetes complicated by serious renal dysfunction, for which nateglinide has been contraindicated in Japan. No subject experienced symptoms of nocturnal or prolonged hypoglycemia. After 12 weeks of nateglinide treatment, decreases were noted in hemoglobin A_1c (0.82%), postprandial glucose (reduced by 59.4 mg/dL to 158.0 mg/dL), and fasting glucose (reduced by 11.7 mg/dL to 122.4 mg/dL). Nateglinide, which demonstrates limited risk of hypoglycemia and effectively controls blood glucose level, is regarded as a useful drug for the treatment of patients with type 2 diabetes.     

Time-dependent effect of an oral hypoglycemic agent upon serum glucose levels

Summary A constant dosage of glibenclamide (50 μg/kg i.p.) was administered to normal mice at 4-h intervals during the day. Blood samples were collected up to 360 min after the injection, for glucose determination. It was found that neither the depth nor the duration of the glibenclamide-induced hypoglycemia was constant throughout the day. These results demonstrate the existence of a circadian rhythm of the glibenclamide effect on serum glucose levels. They also suggest that a day-time schedule of therapy with this drug should result in improved control of serum glucose. Traduzione a cura di G.U.     

老年低血糖脑病误诊分析

目的探讨老年低血糖脑病误诊原因。方法回顾性分析16例老年低血糖脑病患者的临床资料。结果16例老年低血糖脑病患者被误诊为急性脑血管病、癫痫或脑炎。结论老年低血糖脑病易被误诊,临床上对老年突发的意识障碍、癫痫发作及精神异常者应常规行血糖检查,及时确诊并尽早治疗,以免影响预后。     

血清心型脂肪酸结合蛋白联合心肌肌钙蛋白I在低血糖后心肌损害中的诊断价值

目的研究血清心型脂肪酸结合蛋白(H-FABP)联合心肌肌钙蛋白I(cTnI)在低血糖心肌损害中的诊断价值。方法将2013年5月至2015年5月在该院治疗并出现低血糖的糖尿病患者80例纳入本研究;同期体检且一般资料与研究组匹配的80例健康志愿者为对照组。采集两组受试者的血清并测定H-FABP和cTnI水平。结果心肌损伤组患者0~2h H-FABP出现明显升高,以0~2h各指标水平为标准对心肌损伤进行诊断发现H-FABP+cTnI的诊断效能较高,诊断的灵敏度、特异度、阳性预测值、阴性预测值均明显高于单用H-FABP和cTnI进行诊断的患者。H-FABP+cTnI阳性作为诊断标准的阳性患者48h心肌酶谱水平明显高于单cTnI阳性和H-FABP单阳性作为诊断标准的患者,差异有统计学意义(P0.05)。结论联合HFABP和cTnI诊断心肌损伤,有助于减少心肌损伤的漏诊。