Diabetes Monit 2002;3(1):106-117.
인슐린 치료중인 당뇨병 환자에서 야간 저 혈당의 발생 예측
조문숙, 고경수, 이병두
Prediction of Nocturnal Hypoglycemia in Diabetic Patients under Insulin Treatment
Moon Sook Jo, Kyung Soo Ko, Byoung Doo Rhee
Abstract
Background
This study was designed to determine the predictive criteria of significant nocturnal hypoglycemia (that is, plasma glucose concentration is less than 65mg/dL) occuring at admission in adult with IDDM and NIDDM using insulin treatment. Materials and Methods: We selected 48 diabetic patients among those who admitted our hospital from July 1996 to Jun 1997. All patients received twice daily insulin, with the injection of a intermediate acting insulin at 7 A.M. and 5 P.M.. The recommended diet was isocaloric and contained 55~60% carbohydrate, 15~20% protein, and 20~25% fat. The diet was usually divided into three meals and no snacks was recommended. They were asked to complete a questionnaire and check a list of symptoms during the night, which included relavant hypoglycemic symptoms such as dizziness, morning headache, hunger sensation, and nightmare. Blood samples were drawn at 11 P.M., subsequent 3 A.M. and 7A.M.. Blood glucose concentration were measured in whole venous blood by a glucose hexokinase technique, and other biochemical parameters were measured. The t-test was used for statistical analysis. Nocturnal biochemical hypoglycemia was considered when blood glucose concentration was below 65mg/dL. Results: Plasma glucose levels at 3A.M. correlation with age(r=-0.388, 95% confidence interval: -0.12~-0.61, p<0.01),onset age of diabetes(r=-0.367, 95% confidence interval: -0.59~-0.99, p<0.01), plasma glucose level at 11P.M.(r=0.817, 95% confidence interval: 0.69~0.89, p<0.01), and subsequent morning plasma glucose level at 7A.M.(r=0.588, 95% confidence interval: 0.33~0.73, p<0.01) in patients with insulin treatment diabetes mellitus. The comparisons of clinical and biochemical parameters according to the presence of nocturnal hypoglycemic symptoms were not found to be significantly different. Conclusion: The bedtime plasma glucose concentration seems to be a valuable predictor of biochemical nocturnal hypoglycemia, and the subsequent morning fasting plasma glucose concentration was an estimate of preceding biochemical nocturnal hypoglycemia. Age might also be helpful in identifying patients at risk.


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