Abstract To assess the effect of asymptomatic nocturnal hypoglycemia on glycemic control in insulin-dependent diabetes mellitus, we studied, on three nights, 10 patients receiving their usual regimens of continuous subcutaneous insulin infusion. During a control night, the patients' mean (±SE) plasma glucose level reached a nadir of 4.5±0.2 mmol per liter at 3 a.m.; the fasting glucose level was 5.9±0.3 mmol per liter at 7:30 a.m., and a peak glucose level of 8.6±0.3 mmol per liter was reached at 10 a.m., after breakfast. During nights two and three, supplemental insulin was infused intravenously from 10 p.m. to 2 a.m. to simulate a clinical overdose of insulin. On these nights, either hypoglycemia (2.4±0.2 mmol per liter) was permitted to occur or a nearly normal glucose level (5.5 mmol per liter) was maintained by infusion of glucose. The subjects were asymptomatic on all three nights. Despite comparable plasma free insulin levels from 4 to 11 a.m., both fasting (7.3±0.2 mmol per liter) and postbreakfast (12.5±0.4 mmol per liter) plasma glucose levels were significantly higher after hypoglycemia than when hypoglycemia was prevented (6.2±0.2 mmol per liter and 8.7±0.4 mmol per liter, respectively; P<0.001 in both cases). Fasting levels of plasma glucose correlated directly with overnight plasma levels of epinephrine (r = 0.78, P<0.001), growth hormone (r = 0.57, P<0.009), and cortisol (r = 0.52, P<0.02) but correlated inversely with the overnight nadir of plasma glucose (r = -0.62, P<0.005). We conclude that asymptomatic nocturnal hypoglycemia can cause clinically important deterioration in glycemic control (the Somogyi phenomenon) in patients receiving intensive insulin therapy, and should therefore be considered in the differential diagnosis of unexplained morning hyperglycemia.
The Effect of Asymptomatic Nocturnal Hypoglycemia on Glycemic Control in Diabetes Mellitus
DE FEO, Pierpaolo;SANTEUSANIO, Fausto;BOLLI, Geremia Brunetto
1988
Abstract
Abstract To assess the effect of asymptomatic nocturnal hypoglycemia on glycemic control in insulin-dependent diabetes mellitus, we studied, on three nights, 10 patients receiving their usual regimens of continuous subcutaneous insulin infusion. During a control night, the patients' mean (±SE) plasma glucose level reached a nadir of 4.5±0.2 mmol per liter at 3 a.m.; the fasting glucose level was 5.9±0.3 mmol per liter at 7:30 a.m., and a peak glucose level of 8.6±0.3 mmol per liter was reached at 10 a.m., after breakfast. During nights two and three, supplemental insulin was infused intravenously from 10 p.m. to 2 a.m. to simulate a clinical overdose of insulin. On these nights, either hypoglycemia (2.4±0.2 mmol per liter) was permitted to occur or a nearly normal glucose level (5.5 mmol per liter) was maintained by infusion of glucose. The subjects were asymptomatic on all three nights. Despite comparable plasma free insulin levels from 4 to 11 a.m., both fasting (7.3±0.2 mmol per liter) and postbreakfast (12.5±0.4 mmol per liter) plasma glucose levels were significantly higher after hypoglycemia than when hypoglycemia was prevented (6.2±0.2 mmol per liter and 8.7±0.4 mmol per liter, respectively; P<0.001 in both cases). Fasting levels of plasma glucose correlated directly with overnight plasma levels of epinephrine (r = 0.78, P<0.001), growth hormone (r = 0.57, P<0.009), and cortisol (r = 0.52, P<0.02) but correlated inversely with the overnight nadir of plasma glucose (r = -0.62, P<0.005). We conclude that asymptomatic nocturnal hypoglycemia can cause clinically important deterioration in glycemic control (the Somogyi phenomenon) in patients receiving intensive insulin therapy, and should therefore be considered in the differential diagnosis of unexplained morning hyperglycemia.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
