Insulin-induced posthypoglycemic hyperglycemia as a cause of “brittle” diabetes

摘要: Abstract This study evaluated overinsulinization ("Somogyi effect") as a cause of "brittle" diabetes. Although this entity has been discussed in the literature for many years, controversy still exists over whether it is clinically significant or, indeed, at all. Since hypoglycemia often asymptomatic, hyperglycemia and insulin resistance which follow may not be recognized reaction to hypoglycemia. Therefore following clinical clues, indicative posthypoglycemic were validated: (1) asymptomatic periods with urine tests negative sugar ketones, followed by 4+ glycosuria ketonuria early four hours later; (2) wide fluctuations blood levels, frequently unrelated meals, several hours; (3) sharp glycosurie from 0 without intermediate gradations; (4) all day nocturnal sweating, morning hypothermia or headaches. Insulin unresponsiveness, based on tolerance tests, was demonstrated during hyperglycemia. Once suspected basis clues listed, hourly determinations times different routine hospital practice. Proof hyperglycemia, however, depended dramatic reduction quantitative twenty-four hour less erratic gradually reduced dosage. The importance gradual since too rapid caused persistent severe ketonuria.