呋塞米诱导的药物性糖尿病及高胰岛素血症1例报告

A Case Report of Drug-induced Diabetes and Hyperinsulinemia Induced by Furosemide

1名男性非糖尿病的急性脑出血患者,随机血糖波动于6.0~9.0 mmol/L,在使用甘露醇联合呋塞米(20 mg/次,2次/d,静脉注射)减轻脑水肿治疗5 d出现随机血糖进行性升高,最高单日随机血糖波动于11.2~34.7 mmol/L,需普通胰岛素约36 U/d泵入控制血糖;C肽释放试验提示胰岛素抵抗、高胰岛素血症。高渗透性脱水治疗9 d后停用呋塞米,患者随机血糖逐渐恢复至6.2~8.9 mmol/L。经排除其他可能引起血糖升高的疾病及药物后,诊断为呋塞米诱导的药物性糖尿病。该文针对患者病例特点,从血钾、基因多态性、葡萄糖代谢、血清抵抗素及肾功能5个方面对呋塞米引起血糖升高及高胰岛素血症的可能机制做分析;也对该病的治疗经验做出总结。

A male non-diabetic patient with acute cerebral hemorrhage,whose random blood glucose fluctuates between 6.0~9.0 mmol/L,In the use of mannitol combined with furosemide(20 mg/times,2 times/d,intravenous injection)to reduce cerebral edema,there was a progressive increase in random blood glucose for 5 d,and the highest single-day random blood glucose fluctuated between 11.2~34.7 mmol/L.Regular insulin is pumped into about 36 U/d to control blood glucose;C-peptide release test indicated insulin resistance and hyperinsulinemia.Furosemide was stopped after 9 d of hyperosmotic dehydration treatment,and the patient's random blood glucose gradually recovered to 6.2~8.9 mmol/L.After excluding other diseases and drugs that may cause blood sugar to rise,it was diagnosed with furosemide-induced drug-induced diabetes.Based on the characteristics of the patient's case,this article analyzes the possible mechanisms of furosemide-induced blood glucose elevation and hyperinsulinemia from five aspects:blood potassium,gene polymorphism,glucose metabolism,serum resistin and renal function;a summary was made of the treatment experience.