Awakening from Sleep and Hypoglycemia in Type 1 Diabetes Mellitus 英文参考文献.docVIP

Perspectives Awakening from Sleep and Hypoglycemia in Type 1 Diabetes Mellitus Ilan Gabriely , Harry Shamoon * Impaired Counterregulation of Hypoglycemia in Type 1 Diabetes Mellitus Patients suffering from impaired awareness of hypoglycemia in addition to defective counterregulation may be at the greatest risk for developing severe hypoglycemia [4]. con?rmed. Factors that contribute to the development of nocturnal hypoglycemia include preceding physical activity; imbalance between the insulin regimen and the amount, content, and timing of meals; and alcohol consumption. In addition, there may be enhanced sensitivity to insulin, and sleep per se is associated with a decrease in the autonomic response to hypoglycemia [10]. Although most episodes of nocturnal hypoglycemia are asymptomatic, some patients complain of sleep disturbances (vivid dreams or nightmares), morning headache (a “hung-over” sensation), chronic fatigue, or mood changes (mainly depression). As noted above, recurrent episodes of hypoglycemia cause further deterioration of the counterregulatory response to subsequent hypoglycemia. Thus, nocturnal hypoglycemia may be an important factor in precipitating daily hypoglycemia episodes and exacerbating HAAF [11]. The Diabetes Control and Complications Trial in type 1 diabetes (T1DM) unequivocally showed the bene?ts of good glycemic control in preventing the complications of diabetes. Despite the treatment advances of the past decade, today iatrogenic hypoglycemia remains the major impediment to the appropriate control of blood glucose [1]. While imperfect insulin replacement places the patient at increased risk for Hypoglycemia-Associated Autonomic Failure Hypoglycemia-associated autonomic failure (HAAF) describes a clinical syndrome apparently resulting from antecedent episodes of mild hypoglycemia that further degrade the counterregulatory response. As shown experimentally in people without diabetes, recurrent and/or re