女患,68岁。糖尿病史6年。不规则治疗。因发烧、尿频伴食欲不振一周诊断为糖尿病合并泌尿系感染入院。当时查除血糖11.9mmol/L,尿糖(+),尿中除可见数个红、白细胞外余均正常。入院后给予优降糖2.5mg 每日三次及氟哌酸等治疗。于次日中午及下午4点相续出现2次意识不清,且一次重于一次。第2次出现颈抵抗,双侧巴彬斯基征(+)。血糖1.8mmol/L。持续静滴10%葡萄糖,6小时恢复正常。讨论本例为68岁女性,仅口服优降糖5mg即出现低血糖反应致昏迷。其原因考虑主要与年老体弱,食欲不振有关。因此我们认为,糖尿病患者,特别是年老体弱者服优降糖时应从小剂量开始,如食欲不振酌情减量。一旦发生低血糖症立即供糖治疗。意识障碍者应静脉给10%或50%葡萄糖。如无效,可考虑给糖皮质激素。 Female patient, 68 years old. 6 years history of diabetes. Irregular treatment. Due to fever, frequent urination with loss of appetite week diagnosed with diabetes mellitus and urinary tract infection. At that time check the blood glucose 11.9mmol / L, urine (+), in addition to urine can see a few red, white blood cells are more than normal. After admission, given glyburide 2.5mg three times daily and norfloxacin and other treatment. At 2 noon on the next day and at 4 o’clock in the afternoon there were 2 episodes of confusion and more than once. The second occurrence of cervical resistance, bilateral Babinski sign (+). Blood sugar 1.8mmol / L. Continuous intravenous infusion of 10% glucose, 6 hours returned to normal. Discussion This case is a 68-year-old female, only oral glyburide 5mg hypoglycemia that coma. The reasons for considering the main frail, loss of appetite. Therefore, we believe that patients with diabetes, especially those who are elderly and infirm, should begin with small doses of hypoglycemic, such as loss of appetite, as appropriate reduction. In the event of hypoglycemia immediately sugar treatment. People with impaired consciousness should give 10% or 50% glucose intravenously. If invalid, consider giving glucocorticoids.