Relationship Of Glucose Fluctuation And Cortisol, Insulin In Type2DM Patients

Objective to study the status of cortisol(Cor) and insulin(INS) about glucose fluctuation intype2DM patients and explore the relationship of Cor, INS and glucose fluctuation in thesepatients, use treatment of appropriate hydrocortisone and explore the effect of treatment abouthydrocortisone on glucose fluctuation. Method sixty type2DM patients were enrolledabout Cor at8a.m, secrum insulin, serum C-peptide and serum glucose(determine cortisol,secrum insulin, serum C-peptide and serum glucose after OGTT test at0h,0.5h,1h,2h,3h),hemoglobin A1C(HbA1c),the eight period of blood glucose(fasting plasmaglucose, blood glucose before meals, two hours blood glucose after meals, blood glucosebefore sleeping, blood glucose at2o’clock) and magnetic resonance of imaging forhypophysis. according to the coefficient variation(CV) of blood glucose divided into bloodglucose fluctuation group of30cases and blood glucose stable group of30cases, comparetwo groups with Cor,HbA1c,INS,C-peptide differences; evaluate glucose fluctuation bystandard deviation of glucose; evaluate insulin sensitivity by Matsuda insulin sensitivityindex(ISI);evaluate insulin resistance by insulin resistance IR(HOMA-IR); using50mg ofhydrocortisone to intravenous drip for3days to blood glucose stable group,were assayed andanalyzed by standard deviation of glucose. Results the level of cortisol at8a.m ofglucose fluctuation group was lower than blood glucose stable group (P<0.05);the level ofMastuda ISI for glucose fluctuation group was lower than blood glucose stablegroup(P<0.05);glucose fluctuation was negatively relative with cortisol (r=-0.649P<0.05) and ISI(r=-0.529P<0.05); The level of glucose fluctuation which use hydrocortisonein post-treatmen was lower than pretherapy(P<0.05). Conclusion The level of glucosefluctuation in type2DM patients is related with pituitary-adrenal insufficiency and reducedinsulin sensitivity, appropriate supplementary glucocorticoid(Cor) can effectively improve theglucose fluctuation, has a guiding significance for clinical treatment.