2型糖尿病のコントロールが良好な患者における正常な血糖濃度における低血糖の逆調節

G Spyer¹, A T Hattersley, I A MacDonald

¹Department of Vascular Medicine and Diabetes Research, School of Postgraduate Medicine and Health Sciences, Exeter, Devon, UK.

Lancet (London, England)

|December 29, 2000

まとめ

制御された2型糖尿病患者は,高血糖値で症状とホルモンの放出を経験します. この変化した反応は重度の低血糖症から保護するかもしれないが,正常な血糖コントロールを達成することは困難である.

科学分野:

エンドクリノロジーエンドクリノロジー
メタボリック障害メタボリック障害
糖尿病に関する研究

背景:

糖尿病における濃度の血糖コントロールは,しばしば低血糖症によって制限されます.
症状を誘発する特定のグルコースレベルと,制御された2型糖尿病における逆調節性ホルモン放出は,十分に理解されていません.

研究の目的:

健康な対照群と比較して,インスリン治療を受けていない,良好にコントロールされている2型糖尿病患者の症状および対抗調節性ホルモン放出が発生するグルコース濃度を調査する.

主な方法:

7人の2型糖尿病患者と7人の健康な対照群で,段階的な高インスリン血症低血糖グルコースクランプを実施しました.
測定には,症状の認識,認知機能,および各グルコース高原における対抗調節ホルモンレベル (エピネフリン,ノルエピネフリン,成長ホルモン,コルチゾール) が含まれていました.

主要な成果:

糖尿病患者は,対照群よりも血糖濃度が著しく高い症状を報告しました.
エピネフリンを含む反調節性ホルモンの放出は,糖尿病患者の高血糖レベルでも発生しました (例えば,3.8 mmol/L vs. 2.6 mmol/L).

結論:

逆調節性ホルモンの分泌と症状の知覚のためのグルコースの値の変化は,よく制御された2型糖尿病において存在します.
これらの適応は,深い低血糖症から身を守る可能性があるが,臨床実務でノルモグリセミアを達成するには課題を提示する.

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