Study On The Risk Factors Of Norcturnal Hypoglycaemia In Type2Diabetes Mellitus And Related Strategies

Incidence of diabetes increases dramaticly in all the world these years and it hasbecame a chronic non-infectious disease threatening human being’s health. Diabetesand its complications are the main lethal causes and disable causes which increasehealth care cost greatly. Treating to target for diabetes can delay and decrease diabeticmacro-and microvescular complications undoubtedly. However, strict control ofblood glucose will increase the risk of hypoglycaemia, especially norcturnalhypoglycaemia without subjective symptoms. And if not detected in time, severehypoglycaemia may result in irreversible damages of cerebral cortex, also shock,angina, myocardial infarction and cerebral infarction, even threat to life. Therefore,prevention and treatment of norcturnal hypoglycaemia promptly are the focal points inclinical nursing practice.Objective:To investigate the risk factors of norcturnal hypoglycaemia during continuoussubcutaneous insulin infusion treatment with insulin pump and evaluate the differenteffects of different handling ways of hypoglycaemia to make the best strategy ofprevention and treatment for hypoglycaemia.Methods:One hundred inpatient type2diabetic patients with norcturnal hypoglycaemiawere as case group and102other ones without norcturnal hypoglycaemia as controlgroup since2008to2012. All patients were given regular diet and exercise guide aswell as continuous subcutaneous insulin infusion treatment with insulin pump. Dataincluding gender, age, duration, abdominal circumference, BMI, with or withoutdiabetic complication and biochemical indicators such as HbA1c and creatinineclearance rate were collected to analyze the risk factors of norcturnal hypoglycaemia.Monitor fasting plasam glucose, bedtime, midnight and3:00in the morning andcollect the glucose value when hypoglycaemia sympotom appeared to analyze thedifferent effects of different handling ways of hypoglycaemia to make the beststrategy of prevention and treatment for hypoglycaemia.Results:1. Duration, BMI, creatinine, HbA1c and glucose at bedtime were all the riskfactors for norcturnal hypoglycaemia when single factor analysis（P＜0.05）. 2. While it was found that smaller abdominal circumference, lower bedtimeglucose were the risk factors of norcturnal hypoglycaemia during continuoussubcutaneous insulin infusion treatment when multiple factor Logistic regressionanalysis was done（P＜0.05）. In the other hand, higher BMI was the protective factorof norcturnal hypoglycaemia. Age, gender, with or without diabetic nephropathy,retinopathy or neuropathy were not related to accurence of norcturnal hypoglycaemia（P＞0.05）.3.Handling hypoglycaemia improperly is also a risk factor of hypoglycaemia.Total119person-time hypoglycaemia occurred in all100patients with type2diabetes.Continuous hypoglycaemia occurred12person-time after handlinghypoglycaemia（10.1%）; hyperglycaemia occurred23person-times （19.3%）；andsteady blood glucose occurred84person-time（70.6%）. The total rectification rate ofhyperglycaemia was89.9%.Conclusion:1. Norcturnal hypoglycaemia is related to duration, BMI, abdominalcircumference, endogenous creatinine clearance rate, HbA1c and bedtime glucoselevels.2. Smaller abdominal circumference, lower bedtime glucose were the risk factorsof norcturnal hypoglycaemia during continuous subcutaneous insulin infusiontreatment when multiple factor Logistic regression analysis was done.3. Higher BMI may be the protective factor during continuous subcutaneousinsulin infusion treatment in type2diabetes.4. Norcturnal hypoglycaemia is the result of multifactors. Reducing risk factorsand regulating the therapeutic schedule in time is the key point to reduce the riskfactors of norcturnal hypoglycaemia. Clinical nurses should strengthen glucosemonitoring for the patients receiving intensive treatment in order to discover thehypoglycaemia in time, meanwhile they also should be adept in recognizing the singsand sympotoms of hypoglycaemia. The nurses should also grasp the clinical featuresand optimal process flowchart, then implement individual health guidance and avoidunnecessary hypoglyceamia.