第一型糖尿病發生低血糖頻率、原因，危險因素及處置

Frequency, Causes, Risk Factors and Management of Hypoglycemia in Type 1 Diabetes

羅福松(Fu-Sung Lo)

《台灣醫學》 24卷3期 (2020/05) Pp. 280-288

https://doi.org/10.6320/FJM.202005_24(3).0006

摘要

第一型糖尿病確實會影響兒童的大腦發育，高低血糖都會導致智能效率下降，低血糖是第一型糖尿病常見的急性併發症。預防低血糖最有效的工具就是糖尿病患者及周邊家屬朋友的教育及謹慎評估病患的胰島素劑量、藥效、碳水化合物量、運動等種種生活方式，提供個人化的規劃。雖然糖化血色素HbA_1C是唯一被證實為糖尿病慢性血管併發症的血糖控制指標，卻不適用於個別化的差異，甚至會產生誤導。隨著連續性葡萄糖監測（continuous glucose monitoring, CGM）日益普及，葡萄糖管理指標（glucose management indicator, GMI）是CGM測出所有血糖讀數中的平均葡萄糖值。CGM所顯示的動態血糖曲線（ambulatory glucose profile, AGP）的葡萄糖模式圖變化很大，可以用來作個人化的生活方式改變及胰島素調整的參考。最近，糖尿病先進技術和治療（advanced technologies & treatments for diabetes, ATTD）專家提出目標血糖範圍時間（time in range, TIR）的標準化指標。為了達到此目標且預防低血糖發生，目前可用的先進技術，除了CGM外，還有自動胰島素暫緩注射（低血糖時，預測低血糖時）降低了低血糖的持續時間。與傳統的胰島素幫浦療法相比，新的技術（閉環人工胰臟系統）改善了糖尿病患者的血糖控制並降低了低血糖的發生。

關鍵字

第一型糖尿病 ； 低血糖 ； 連續性葡萄糖監測（CGM） ； 葡萄糖管理指標（GMI）

並列摘要

Type 1 diabetes does affect children's brain development. High and low blood glucose levels can lead to decreased intelligence efficiency. Hypoglycemia is a common acute complication of type 1 diabetes. The most effective tool for preventing hypoglycemia is the education for diabetic patients, their family members and friends, and careful assessment of the patient's insulin dosage, efficacy, carbohydrate intake, exercise, other lifestyles, and providing personalized planning. Although glycated hemoglobin A1c is the only blood glucose control indicator that has been proven closely related with chronic vascular complication of diabetes, it is not applicable to individual differences and may even be misleading. With the popular application of continuous glucose monitoring (CGM), the glucose management indicator (GMI) is the average glucose value of all blood glucose readings taken by the CGM. The glucose pattern of the ambulatory glucose profile (AGP) displayed by CGM varies widely and can be used as a reference for personalized lifestyle and insulin adjustments. Recently, experts of advanced technologies & treatments for diabetes (ATTD) have proposed standardized indicators of Time in Range (TIR). In order to achieve the goal and prevention of hypoglycemia, currently available advanced technology, in addition to CGM, sensor-augmented pump therapy with the function of predicting low glucose level then suspends insulin delivery on or before development of low glucose level and can reduce the duration of hypoglycemia. Compared with traditional insulin pump therapy, the new product, closed-loop system improves glycemic control and reduces the incidence of hypoglycemia in patients with diabetes.

並列關鍵字

type 1 diabetes ； low blood sugar ； continuous glucose monitoring (CGM) ； glucose management indicator (GMI)

參考文獻

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