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首页> 外文期刊>Endocrine practice: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists >Contribution of the dawn phenomenon to the fasting and postbreakfast hyperglycemia in type 1 diabetes treated with once-nightly insulin glargine
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Contribution of the dawn phenomenon to the fasting and postbreakfast hyperglycemia in type 1 diabetes treated with once-nightly insulin glargine

机译：每晚进行一次甘精胰岛素治疗的1型糖尿病的空腹和早餐后高血糖的黎明现象的贡献

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Objective: To observe the effect of the dawn phenomenon on basal glucose and postbreakfast hyperglycemia in patients with type 1 diabetes treated with once-nightly insulin glargine and premeal insulin lispro.Methods: In 49 study subjects consuming a fixed isocaloric (50% carbohydrate) diet of usual food, the insulin glargine dose was titrated from daily continuous glucose monitoring downloads to achieve a basal glucose goal of <130 mg/dL 4 hours after meals and during serial meal omissions but with fewer than 10% of readings at <70 mg/dL during 24 hours. Patients also performed self-monitoring of plasma glucose 7 times a day (before and 2 hours after each meal or omitted meal and at bedtime).Results: The target mean basal glucose level was achieved only during the non-dawn phenomenon period (1400 hours to 0400 hours). During the dawn phenomenon, the mean (standard deviation) basal glucose level increased from 118 (57) mg/dL at 0400 hours to 156 (67) mg/dL before the breakfast meal, a 32% increase (P =.00149). The mean self-monitored plasma glucose level with meal omission was 63.8% of that increase with a breakfast meal.Conclusion: The fasting morning glucose concentration is considerably elevated because of the dawn phenomenon. Targeting insulin titration to this glucose level may result in excessive basal insulin dosing for the non-dawn phenomenon periods of the day. The dawn phenomenon is a large component of the postbreakfast hyperglycemia. Rather than increasing the morning premeal insulin bolus, consideration should be given to pretreating the earlier dawn phenomenon with an insulin pump with use of a variable basal insulin rate.
机译：目的：观察黎明现象对每晚一次甘精胰岛素和赖脯胰岛素胰岛素治疗的1型糖尿病患者基础葡萄糖和早餐后高血糖的影响。方法：在49名接受固定等热量（50％碳水化合物）饮食的研究对象中在日常饮食中，从每天连续的葡萄糖监测下载中滴定了甘精胰岛素的剂量，以使饭后4小时和连续进餐期间的基本葡萄糖目标<130 mg / dL，但在<70 mg / d时读数少于10％ 24小时内的dL。患者还每天进行7次血浆葡萄糖自我监测（每次进餐或不进餐前和进餐后2小时以及就寝时间）。结果：目标平均基础血糖水平仅在非黎明现象期间（1400小时）达到至0400小时）。在黎明现象期间，平均基础葡萄糖含量（标准差）从0400小时的118（57）mg / dL增加到早餐前的156（67）mg / dL，增加了32％（P = .00149）。进餐时平均自我监测的血浆葡萄糖水平随进餐而增加了63.8％。结论：由于黎明现象，空腹早晨血糖浓度显着升高。将胰岛素滴定目标设定为该葡萄糖水平可能会导致一天的非黎明现象期间过量使用基础胰岛素。黎明现象是早餐后高血糖的重要组成部分。不应增加早晨的餐前胰岛素推注，而应考虑使用胰岛素泵，使用可变的基础胰岛素剂量来治疗较早的黎明现象。

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