小剂量胰岛素治疗糖尿病酮症酸中毒中的低血糖及其反应症状

目的　避免小剂量胰岛素治疗糖尿病酮症酸中毒中出现低血糖及其反应症状。方法　回顾性分析 31例使用小剂量胰岛素治疗糖尿病酮症酸中毒过程中出现低血糖及其反应症状患者的临床资料。结果　 31例患者 (占同期治疗DKA的 7.8% )入院时血糖无差异。急性低血糖反应组 9例比慢性低血糖反应组 17例的胰岛素应用速度、血糖下降速度快。 5例未发现低血糖。出现低血糖后 ,有 5例再次出现尿酮体阳性 ,其中 1例出现低血糖昏迷 ,1例出现脑水肿昏迷。结论　应用小剂量胰岛素治疗糖尿病酮症酸中毒过程中仍可发生低血糖或低血糖反应症状 ,加强血糖监测可及时发现低血糖 ,及时处理可减少低血糖的危害。

Hypoglycemia During Treatment of Diabetic Ketoacidosis by Low-dose Insulin

Objective To explore the prevention of hypoglycemia and hypoglycemic symptoms during the therapy of diabetes ketoacidosis(DKA) with low-dose insulin.Methods Clinical data of 31 cases with DKA who developed hypoglycemia or hypogycemic symptoms when treated with low-dose insulin were retrospectively analyzed.Results 31 cases accounted for 7.8% at the same period of treatment of DKA.The blood glucose was not different in slcases on admission.Insulin infusion rate was higher and glucose leve1 dropped faster in acute hypoglycemia group than the chronic hypoglycemia group.The development of unaware hypoglycemia may be due to the autonomic neuropathy and gradua1 decline of blood glucose.When hypoglycemia happened,ketouria was changed to be positive again in 5 cases,one developed hypoglycemia coma and one developed brain edema coma.Conclusion The hypoglycemia and hypoglycemic symptoms can still happen during the therapy of DKA with the low-dose of insulin,which can worsen the condition the patient.Intensive blood glucose monitoring can timely detect the hypoglycemia which can decrease the danger of hypoglycemia.