摘要

BACKGROUND: Nocturnal hypoglycemia frequently occurs in patients with type 1 diabetes mellitus (T1DM). It can be fatal and is believed to promote the development of the hypoglycemia-unawareness syndrome. Whether hypoglycemia normally provokes awakening from sleep in individuals who do not have diabetes, and whether this awakening response is impaired in T1DM patients, is unknown. METHODS AND FINDINGS: We tested two groups of 16 T1DM patients and 16 healthy control participants, respectively, with comparable distributions of gender, age, and body mass index. In one night, a linear fall in plasma glucose to nadir levels of 2.2 mmol/l was induced by infusing insulin over a 1-h period starting as soon as polysomnographic recordings indicated that stage 2 sleep had been reached. In another night (control), euglycemia was maintained. Only one of the 16 T1DM patients, as compared to ten healthy control participants, awakened upon hypoglycemia (p = 0.001). In the control nights, none of the study participants in either of the two groups awakened during the corresponding time. Awakening during hypoglycemia was associated with increased hormonal counterregulation. In all the study participants (from both groups) who woke up, and in five of the study participants who did not awaken (three T1DM patients and two healthy control participants), plasma epinephrine concentration increased with hypoglycemia by at least 100% (p < 0.001). A temporal pattern was revealed such that increases in epinephrine in all participants who awakened started always before polysomnographic signs of wakefulness (mean +/- standard error of the mean: 7.5 +/- 1.6 min). CONCLUSIONS: A fall in plasma glucose to 2.2 mmol/l provokes an awakening response in most healthy control participants, but this response is impaired in T1DM patients. The counterregulatory increase in plasma epinephrine that we observed to precede awakening suggests that awakening forms part of a central nervous system response launched in parallel with hormonal counterregulation. Failure to awaken increases the risk for T1DM patients to suffer prolonged and potentially fatal hypoglycemia.

译文

背景: 1 型糖尿病 (T1DM) 患者经常出现夜间低血糖。它可能是致命的,并且被认为会促进低血糖-无意识综合征的发展。在没有糖尿病的个体中,低血糖症是否通常会引发睡眠觉醒,T1DM 患者的这种觉醒反应是否受损,尚不清楚。方法和结果: 我们分别测试了两组 16 名 T1DM 患者和 16 名健康对照参与者,其性别、年龄和体重指数分布具有可比性。一夜之间, 当多导睡眠图记录显示达到第二阶段睡眠时,通过在 1 小时内开始注射胰岛素,血浆葡萄糖线性下降到 2.2 毫摩尔/升的最低点水平。在另一个晚上 (对照),血糖维持正常。与 10 名健康对照参与者相比,16 名 T1DM 患者中只有一人在低血糖时醒来 (p = 0.001)。在对照组的夜晚,两组中的任何一组的研究参与者都没有在相应的时间醒来。低血糖期间的觉醒与激素调节增加有关。在所有醒来的研究参与者 (两组) 中,在五名没有醒来的研究参与者 (三名 T1DM 患者和两名健康对照参与者) 中, 血浆肾上腺素浓度随着低血糖增加至少 100% (p & lt; 0.001)。揭示了一种时间模式,即所有被唤醒的参与者的肾上腺素增加总是在多导睡眠标志觉醒之前开始 (平均值/-平均值的标准误差: 7.5/-1.6 分钟)。结论: 血糖降至 2.2 mmol/l 会引起大多数健康对照参与者的觉醒反应,但这种反应在 T1DM 患者中受损。我们在觉醒之前观察到的血浆肾上腺素的反调节增加表明觉醒是中枢神经系统反应的一部分,与激素的反调节同时启动。未能唤醒会增加 T1DM 患者长期和潜在致命低血糖的风险。

Type 1 diabetes mellitus

内分泌 糖尿病 疾病
概述  :  

1型糖尿病是指人体无法产生足够的胰岛素来控制血糖水平的疾病。1型糖尿病以前称为胰岛素依赖型糖尿病或青少年糖尿病。1型糖尿病是一种自身免疫性疾病,这意味着当人体的免疫系统攻击体内的细胞时就开始了。在1型糖尿病中,免疫系统会破坏胰腺中的胰岛素产生细胞(β细胞)。诊断最常见的年龄是10至16岁,1型糖尿病对男性和女性的影响相同。临床表现症状通常突然而强烈,通常最突出的症状是排尿过多和口渴,这是因为血液中葡萄糖的增加导致肾脏比平时产生更多的尿液。尿液中流失的液体会使人脱水,脱水导致口渴,儿童可能会再

type   英 /taɪp/   美 /taɪp/

释    义   n. 类型,品种;模范;样式

               vt. 打字;测定(血等)类型

               vi. 打字

               n. (Type)人名;(英)泰普

同根词   typewritten adj. 用打字机打出的,打字的

               typewriter n. 打字机

               typewriting v. 用打字机打

例    句   What type of movies do you like?你喜欢看哪种类型的电影?

 

diabetes   英 /ˌdaɪəˈbiːtiːz/   美 /ˌdaɪəˈbiːtiːz/

释    义   n. 糖尿病;多尿症

同根词   diabetic adj. 糖尿病的,患糖尿病的

               diabetic n. 糖尿病患者

例    句   It is like diabetes or asthma, an illness, due to a build up of pressures, which can happen to anyone. 就像是糖尿病或者哮喘,由于压力的形成,这种病有可能发生在任何人身上。

 

mellitus

释    义   n. 糖尿病

例    句   Gestational diabetes mellitus is that sugar metabolism unusual first happens or be found during pregnancy, is one of the most common obstetrics complications. 妊娠期糖尿病是妊娠期首次发生或发现的糖代谢异常,是妊娠期最常见的产科并发症之一。

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