老年糖尿病低血糖症临床诊治分析

目的探讨老年糖尿病低血糖症的临床诊治。方法分析62例患者的临床资料。结果62例中，58例经治疗后急性低血糖反应症状缓解、血糖恢复；1例昏迷〉4h，于治疗12～48h后清醒，1例留有轻度痴呆。2例死于低血糖昏迷合并多脏器功能衰竭。结论老年糖尿病患者应加强糖尿病教育和自我监测，防止意外的发生；临床医师应提高对老年糖尿病低血糖症的认识和警惕，做到及早发现，及早治疗，避免留下后遗症。     

降糖药引起低血糖昏迷12例临床分析

糖尿病患者使用降糖药物过量,或对糖尿病诊断不十分明确的老年人随便使用降糖药物常常引起低血糖,严重者可出现致命的低血糖昏迷。现将我院收治的12例由于降糖药使用不当所引起的低血糖昏迷患者情况报道如下: 1 临床资料 本组病例男7例、女5例,年龄58～78岁,平均69岁,其中昏迷前确诊为Ⅱ型糖尿病患者9例,3例诊断不明确仅只有尿糖(+),后经检查皆非糖尿病,12例入院时均有不同程度的昏迷,2例出现癫痫样抽搐,昏迷前8例服用消渴丸,2例服用消渴丸+降     

17例低血糖昏迷的原因分析

目的通过分析17例低血糖昏迷患者的常见因素,探讨防范低血糖昏迷发生的措施。方法回顾性分析17例低血糖昏迷患者的临床资料,入院后均行头颅CT检查,排除脑血管急性病变,立即给予血糖测定、心电监护、吸氧、保持呼吸道通畅,一经确诊给予50%葡萄糖40～80mL静脉推注,症状无好转者给予20%甘露醇或氢化可的松静脉滴注,并监测血糖,观察患者的临床治疗效果。结果经过积极的抢救和治疗,15例(88.24%)昏迷患者10～40min意识转清,3d后痊愈出院。2例(11.76%)患者血糖纠正后仍处于昏迷状态,给予氢化可的松静脉点滴后好转,1周后痊愈出院,其中2例(11.76%)重度昏迷患者出现记忆力减退和反应迟钝。结论对于低血糖昏迷患者应及时确诊、对症处理,加强对糖尿病患者的健康教育,合理用药,科学饮食,去除诱因,预防低血糖昏迷的发生。     

老年糖尿病低血糖临床防治分析

对42例老年糖尿病低血糖患者的临床资料进行回顾性分析。探讨使用降糖药物后老年糖尿病患者出现低血糖现象的诊治和预防经验。1 临床资料 42例患者,年龄65～84岁。均为2型糖尿病,糖尿病史半年至35年,平均15年。住院期间发生低血糖8例,以低血糖收入院的34例,其中低血糖昏迷的28例,血糖〈3．9mmol／L的9例,血糖〈2．8mmol／L的33例。     

老年糖尿病低血糖症临床诊治分析

目的探讨老年糖尿病低血糖症的临床诊治。方法分析50例患者的临床资料。结果 50例中,48例经治疗后急性低血糖反应症状缓解、血糖恢复;1例昏迷〉4h,于治疗12～48h后清醒,1例留有轻度痴呆。结论老年糖尿病患者应加强糖尿病教育和自我监测,防止意外的发生;临床医师应提高对老年糖尿病低血糖症的认识和警惕,做到及早发现,及早治疗,避免留下后遗症。     

院内护理会诊对糖尿病患者低血糖恐惧影响的研究

<正>糖尿病作为临床常见的存在遗传特质的疾病,临床特点表现为患者的血糖水平升高,常伴随患者终身,故对患者的血糖水平进行有效控制为临床治疗糖尿病的关键[1]。目前,临床医学针对糖尿病多以药物治疗为主,但若患者于注射胰岛素、服用降糖药物治疗期间出现应用不规范情况,或是运动量增加,可造成低血糖,重者发生低血糖昏迷[2]。而患者出现低血糖昏迷后可损害机体,对患者的中枢神经系统造成不可逆性损伤;同时低血糖昏迷患者易出现恐惧情绪,而为避免     

低血糖脑病诊治分析(附10例报告)

由于减肥不当及糖尿病患者不合理用药,致使发生低血糖反应的患者增多,有的甚至出现低血糖脑病,如不及时治疗将导致残疾甚至死亡。现将诊断明确的10例低血糖脑病患者资料分析如下:1临床资料1.1病例资料本组男4例,女6例。年龄20～78岁,平均56岁。发病时间:凌晨发病4例,上午发病1例,下午发病2例,晚上发病3例。既往有糖尿病史2例,均为2型糖尿病。病前有感染史3例;进食少7例,其中4例为减肥节食。临床表现:有精神症状2例,表现为烦躁,语言增多,语无伦次;昏迷5例;癫痫发作2例,其中1例为癫痫持续状态;一侧肢体瘫痪1例,双下肢体瘫痪1例,双下肢巴宾斯基…     

糖尿病低血糖昏迷伴偏瘫15例分析

随着人民生活水平的提高及生活方式的改变,糖尿病的发病率逐年升高。糖尿病患者在治疗过程中出现的低血糖血症,甚至低血糖昏迷伴偏瘫在临床上并不少见。我院2001～2005年共收治15例糖尿病低血糖昏迷伴偏瘫患者,现对其临床资料进行回顾性分析。1临床资料1·1一般资料本组15例糖尿病低血糖昏迷伴偏瘫患者中,男11例,女4例。发病年龄50～70岁。既往有糖尿病病史15例,合并高血压病史5例,冠心病3例,脑血管病史2例。长期应用胰岛素2例,长期单独口腹格列苯脲(商品名:优降糖)2例。优降糖与二甲双胍合用8例,优降糖与达美康合用1例,单独口服达美康2例,…     

老年低血糖昏迷患者的临床分析

目的探讨老年低血糖昏迷患者的易患原因及临床治疗转归。方法选取我院从2007年2月至2012年3月所收治的35例老年低血糖昏迷患者及35例无低血糖昏迷的糖尿病患者作为临床研究对象,所有低血糖患者一旦确诊,立刻建立静脉通道,给予吸氧和50%的葡萄糖40~100mL静注。结果 35例低血糖患者当中,30例在数分钟至数小时后回复意识清醒,且在1周内陆续出院,其中有4例出现显著的记忆力减退与反应迟钝。死亡5例,其中3例由于发病至治疗时间太长,因此分别在昏迷24h、36h和10d后死亡;2例由于心脏病突发抢救无效死亡。结论在临床上加强对糖尿病患者的健康教育,选择适合的治疗药物与治疗方案,同时定期进行血糖检测,都有利于低血糖昏迷的预防。而一旦低血糖昏迷发生后,及时进行治疗,且无合并其他严重疾病,一般患者都可有较好预后。     

337例低血糖昏迷院前急救的分析

目的探讨低血糖昏迷的院前急救治疗方法及救治效果。方法取出2013年1月至2013年12月上海市医疗急救中心院前急救伴有低血糖的昏迷病例总计337例。其中现场救治苏醒的221例作为Ⅰ组,现场救治未苏醒的116例作为Ⅱ组进行对照分析。结果两组比较在既往有无糖尿病史、糖尿病类型、发病先兆症状、呼救时间、完成纠正、现场转归、救治后血糖值等方面差异明显有统计学意义。患者年龄、救治平均时间、现场测得血糖值等方面差异不大。结论在院前急救中针对低血糖昏迷患者应力争在现场诊断,完成纠正治疗,积极促转归,减少患者因长时间缺糖昏迷造成不良预后,建议将血糖监测作为院前昏迷患者常规检查项。     

Severe and resistant hypoglycemia associated with concomitant gatifloxacin and glyburide therapy

Severe and resistant hypoglycemia occurred in two patients with diabetes mellitus who were receiving concomitant gatifloxacin and glyburide. An 84-year-old woman treated with glyburide for type 2 diabetes mellitus experienced, for the first time, a severe episode of hypoglycemia after 2 days of gatifloxacin 400 mg/day for nonproductive cough. Her blood glucose level on hospital admission was 28 mg/dl. Gatifloxacin and glyburide were discontinued, and the patient was treated with intravenous dextrose infused over 36 hours. Glyburide was restarted before her discharge, with no recurrence of hypoglycemia. A 79-year-old man with type 2 diabetes mellitus treated with glyburide was prescribed gatifloxacin 400 mg/day for pneumonia. After 1 day of therapy, the patient was admitted to the emergency department in a coma. His blood glucose level was 18 mg/dl. Despite discontinuation of gatifloxacin and oral hypoglycemic therapy, hypoglycemia was reversed only after administration of multiple boluses of intravenous dextrose, followed by intravenous dextrose infused over 48 hours. On hospital day 7, gliclazide and levofloxacin were started; the patient experienced no recurrence of hypoglycemia and was discharged on day 10. Several cases of severe and resistant hypoglycemia associated with gatifloxacin therapy have been reported in the recent literature. Although the exact mechanism is not fully understood, it may be linked to a gatifloxacin-induced closing of the adenosine 5'-triphosphate-sensitive potassium channels in the pancreatic beta cells, leading to insulin secretion. The onset of hypoglycemia in relation to the start of gatifloxacin suggests that the drug precipitated this adverse event. Patients receiving oral hypoglycemic agents are at greater risk of experiencing gatifloxacin-induced hypoglycemia than patients not receiving these agents. Clinicians should be aware of this potentially life-threatening adverse event and monitor blood glucose levels in all patients receiving concomitant oral hypoglycemic agents and gatifloxacin.     

糖尿病患者低血糖昏迷的急诊护理

目的糖尿病患者发生低血糖昏迷不在少数,急诊有时难以鉴别,本文拟总结护理糖尿病患者发生低血糖昏迷的方案。方法严格按诊断标准选择本院61例糖尿病低血糖昏迷患者,随机分为实验组与对照组,比较缓解率及血糖恢复情况.结果发现实验组较对照组临床缓解率更高,血糖情况控制更好,二组对比有统计学意义。结论糖尿病患者合并低血糖昏迷做好急诊护理工作,可使患者症状较快缓解,提高患者生存率。     

急诊低血糖症87例诊治分析

目的探讨急诊低血糖症快速诊断与治疗方法。方法回顾性分析87例低血糖症患者的临床资料,其中有糖尿病史的患者61例,不同症状的患者采取不同的治疗方法。结果经急诊治疗后,其中81例患者低血糖症状得到缓解、消失,意识清醒后离院;4例患者低血糖纠正后,意识状态无好转,留院进一步治疗;2例昏迷患者因昏迷时间过长,并发肺部感染,经抢救无效死亡。结论急诊内科医生应加强对低血糖症的认识,能迅速准确诊疗,采取积极有效的补糖治疗方案,减少死亡率。     

低血糖脑病50例临床分析

目的总结本院收治低血糖脑病患者的诊治经验。方法回顾性分析50例低血糖脑病的临床资料。结果 50例患者37例首诊即诊断低血糖脑病,13例误诊为脑血管意外,但最终均确诊为低血糖脑病,经抢救49例治愈,1例死亡。结论低血糖脑病是是临床常见急症之一,所有昏迷或其他脑功能障碍表现的患者均需行末梢血糖检测,以提高急救水平,避免误诊误治,对于糖尿病患者,尤其老年人,需加强饮食及用药指导,强化血糖监控,防治严重低血糖引起不可逆的脑损害。     

口服降糖药联合甘精胰岛素治疗2型糖尿病的疗效观察

目的 观察在口服降糖药的基础上联合甘精胰岛素治疗2型糖尿病（T2DM）的临床效果。方法对49例单用降糖药效果欠佳的T2DM患者联用甘精胰岛素治疗,分别于治疗前及治疗后（3个月）观察空腹血糖（FPG）、餐后2h血糖（2hPG）、血脂、血压、体重指数的变化。结果联用甘精胰岛素治疗后FPG、2hPG、HbA1c较治疗前明显下降（P〈0．01）,而血脂、血压、体重指数影响不大,且无明显低血糖反应。结论口服降糖药联合甘精胰岛素治疗方案具有作用佳、安全性好的特点。     

比较动态血糖监测与指尖血糖监测对2型糖尿病患者低血糖事件的重要意义

目的比较动态血糖监测系统(cotinnuous glucose monitoring system,CGMS)与指尖监测血糖在2型糖尿病患者胰岛素治疗过程中低血糖事件的意义。方法应用CGMS对住院的70例2型糖尿病患者进行72h的血糖监测,同时用指尖血糖监测仪,每天至少监测7次血糖,观察比较低血糖事件发生的情况。结果指尖血糖监测仅发现15例21次低血糖,而CGMS发现30例出现110次低血糖,其中20例出现无症状性低血糖(Unawareness of hypoglycemia,HU),以夜间多见。结论 CGMS是目前监测糖尿病患者低血糖事件较为先进的手段。     

加用维格列汀对胰岛素治疗的2型糖尿病患者无症状低血糖发生率的影响

目的观察接受胰岛素治疗的2型糖尿病患者加用二肽基肽酶Ⅳ抑制剂维格列汀后,其低血糖(包括无症状低血糖事件)发生率能否降低。方法将2018年3月至9月于我院内分泌科接受胰岛素治疗的80例2型糖尿病患者随机分为研究组(联用维格列汀共40例)和对照组(不联用二肽基肽酶Ⅳ抑制剂共40例),监测其4周内发生的低血糖事件(包括无症状低血糖),比较两组发生低血糖的例数及事件数,并观察4周后所有患者血糖参数的变化。结果研究组和对照组发生低血糖总人数(18例次对23例次)[包括无症状低血糖的人数(10例次对16例次)]差异无统计学意义(P>0.05);研究组无症状低血糖事件数(14例次对27例次)少于对照组(P<0.05),总低血糖事件数(33例次对52例次)亦少于对照组(P<0.05)。Poisson回归分析显示无感知低血糖事件的发生与糖尿病病程(P<0.01)、空腹血糖(P<0.05)和研究组别(P<0.05)相关。4周后研究组和对照组的糖化血红蛋白、糖化白蛋白、空腹和餐后血糖均改善(P<0.05)。结论在接受胰岛素治疗的2型糖尿病患者中,加用维格列汀在改善其血糖控制同时,亦可降低无症状低血糖事件的发生率并减少总低血糖事件的发生。     

Causes of hyperglycemia and hypoglycemia in adult inpatients.

PURPOSE: The underlying causes of hyperglycemia and hypoglycemia in adult medical and surgical inpatients were studied. METHODS: Hyperglycemic and hypoglycemic events occurring in adult medical and surgical patients admitted between February and July 2003 to a tertiary care hospital were identified prospectively from automated daily printouts of abnormal blood glucose levels generated by the hospital laboratory. Information on the causes of a random sample of events was ascertained within 24 hours through chart review and provider and patient interviews. Narratives were presented to an expert committee to assess the causes of each event and preventability. RESULTS: Eighteen of 24 hypoglycemic events and 26 of 26 hyperglycemic episodes were considered preventable. Failure to adjust antidiabetic drugs in response to decreases in oral intake and unexpected deviation from normal hospital routine were the most common factors contributing to hypoglycemia. Hyperglycemia was most often associated with an unwillingness of providers to take responsibility for diabetes management and the exclusive use of sliding-scale insulin regimens. CONCLUSION: Hyperglycemia and hypoglycemia in medical and surgical inpatients were mostly related to inadequate prescribing, monitoring, and communication practices.     

Severe hypoglycemia from clarithromycin-repaglinide drug interaction

Many drugs have been reported to interact with repaglinide in patients with type 2 diabetes mellitus, resulting in hypoglycemia. However, to our knowledge, an interaction between clarithromycin and repaglinide in these patients has not been previously reported. We describe an 80-year-old man with end-stage renal disease and well-controlled type 2 diabetes (hemoglobin A1c < 7%) who was hospitalized for treatment of severe hypoglycemia. He had been receiving repaglinide 0.5 mg 3 times/day for the previous 2 years. Clarithromycin 500 mg twice/day had been started for Helicobacter pylori infection several days before admission. Within 48 hours of starting the drug, he developed severe hypoglycemia, which resolved with intravenous glucose administration. However, 48 hours later, the patient again experienced hypoglycemia and was unresponsive. Intravenous glucose administration again resolved the problem. Repaglinide was discontinued, and no further hypoglycemic episodes occurred. Clinicians should be aware of this possible clarithromycin-repaglinide interaction; in particular, in elderly patients with type 2 diabetes who are taking repaglinide and begin clarithromycin therapy, blood glucose levels should be monitored closely for potential dosage adjustment of repaglinide.