糖尿病

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长期反复低血糖，是胰岛素瘤在捣蛋

2018-06-26 徐璐 糖尿病天地

低血糖胰岛素瘤糖尿病
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正常人的胰岛素分泌恰到好处，如分泌量减少或相对不足，就会发生高血糖，引起众所周知的糖尿病；当出现胰岛素瘤时，就会无节制地释放胰岛素，引起低血糖。

正常人的胰岛素分泌恰到好处，如分泌量减少或相对不足，就会发生高血糖，引起众所周知的糖尿病；当出现胰岛素瘤时，就会无节制地释放胰岛素，引起低血糖。

糖尿病患者不易早期发现胰岛素瘤

胰岛素瘤又称胰岛β细胞瘤，是一种以分泌大量胰岛素而引起发作性低血糖症候群为特征的疾病，初发时症状较轻，时间较短，主要表现为交感神经兴奋，如面色苍白、四肢发凉、出冷汗、心悸、手颤腿软。严重者可表现为意识障碍，如精神恍惚、啫睡、昏迷等。这与糖尿病低血糖时的症状几乎一样。在正常情况下，健康人发生低血糖的频率不高，所以一旦较频繁出现低血糖症状，就会去就医，也就能及早发现胰岛素瘤。但是对于糖尿病患者，特别是注射胰岛素的患者，低血糖本来就如影随形，一旦发生，很容易联想到糖尿病治疗方案出现了问题，比如吃得太少、运动太多或者胰岛素注射过量等，进而调整胰岛素治疗方案，导致不能早期发现病情，使得胰岛素瘤兴风作浪。

如何鉴别糖尿病引起的低血糖和胰岛素瘤引起的低血糖

表1 胰岛素瘤和糖尿病引起的低血糖区别


以上胰岛素瘤的五个临床表现称为“五联征”。如果临床医生遇到低血糖的糖尿病患者，其低血糖症状符合“五联征”，就要考虑胰岛素瘤了。

胰岛素瘤治疗的关键在于早期发现，在低血糖反应还未损伤中枢神经系统前及时接受治疗。90%的胰岛素瘤为良性肿瘤，早期手术切除即可完全治愈。然而胰岛素瘤不易被发现，从而导致延误病情，这需要引起临床医生的重视。如果未能早期发现胰岛素瘤，之后低血糖的发作频率和症状会日益加重，甚至一日数次。长期而严重的低血糖反应最终可致中枢神经系统发生器质性改变，逐渐出现持续的性格异常，记忆力及性格均有减退，精神失常，妄想乃致痴呆等精神障碍。因此，胰岛素瘤常被误诊为癫痫、神经症、精神分裂症、脑瘤或脑血管意外等疾病，有的误诊长达十多年，给患者造成不可挽回的损失。

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    2018-12-12 baoya

    #胰岛#

    0

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    2018-06-28 wwzzly

    #胰岛素瘤#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1749978, encodeId=e0c01e4997856, content=<a href='/topic/show?id=be7c8385345' target=_blank style='color:#2F92EE;'>#胰岛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83853, encryptionId=be7c8385345, topicName=胰岛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a7a536274692, createdName=baoya, createdTime=Wed Dec 12 11:05:00 CST 2018, time=2018-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597036, encodeId=3c6b159e03609, content=<a href='/topic/show?id=e8fe8390e1f' target=_blank style='color:#2F92EE;'>#胰岛素瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83907, encryptionId=e8fe8390e1f, topicName=胰岛素瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b1f718466597, createdName=wwzzly, createdTime=Thu Jun 28 03:05:00 CST 2018, time=2018-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=327169, encodeId=37ea32e16962, content=一起学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/TDiaAWyicHgedzX3wKo3qcxudVJib7AfibfvNeufHRF2jG3Bw8MmZyWjIhtBV1mpJI7Sy9n7RcBKK5t3CuOKuOFxkg/0, createdBy=dd702206933, createdName=wzb521zf, createdTime=Tue Jun 26 13:37:24 CST 2018, time=2018-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=327163, encodeId=841532e163d2, content=低血糖和高血糖的鉴别诊断, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Tue Jun 26 13:21:06 CST 2018, time=2018-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=327155, encodeId=705032e15500, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=82311653708, createdName=医者仁心5538, createdTime=Tue Jun 26 13:15:39 CST 2018, time=2018-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=327156, encodeId=b41832e15648, content=学习了.谢谢分享., beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Jun 26 13:15:38 CST 2018, time=2018-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=327144, encodeId=eb2f32e144f6, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2ac82155377, createdName=1201e5c5m39暂无昵称, createdTime=Tue Jun 26 13:02:10 CST 2018, time=2018-06-26, status=1, ipAttribution=)]
    2018-06-26 wzb521zf

    一起学习学习

    0

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    2018-06-26 flysky120

    低血糖和高血糖的鉴别诊断

    0

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    2018-06-26 医者仁心5538

    学习了

    0

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    2018-06-26 惠映实验室

    学习了.谢谢分享.

    0

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    2018-06-26 1201e5c5m39暂无昵称

    学习了

    0

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