糖尿病是一种以血液中葡萄糖含量过高为特征的代谢性疾病.老年糖尿病患者在治疗的过程中,常发生医源性低血糖昏迷,并易误诊为脑血管意外.现根据我院所遇10例,对其发生和误诊的原因,以及诊治要点提出讨论.以引起同道重视.1 典型病例例1:男,76岁,患高血压病10余年.1991年2月因口干、乏力来我院门诊,查血糖20mmol/L,尿糖+ + +、诊断非胰岛素依赖型糖尿病(NIDDM),给予优降糖2.5mg,2次/日.1992年2月10日晚打麻将3小时后就寝、于次日凌晨被发现神志不清、小便失禁而送医院急诊.查:T36.5℃,P84次/分,R2O次/分,BP22/12kPa.呈浅昏迷状、双侧瞳孔等大等圆,直径3.5mm、光反射迟钝,嘴角左歪,流诞,压眶上神经,右肢未见活动,巴氏征可疑,诊断脑血栓形成及糖尿病.当时考虑生理盐水可能加重脑水肿给予5%葡萄糖水静滴,同时予以20%甘露醇脱水.3小时后 Diabetes mellitus is a metabolic disease characterized by high glucose in the blood.Dead diabetes patients often have iatrogenic hypoglycemic coma during the course of treatment and are easily misdiagnosed as cerebrovascular accidents. 10 cases, the reasons for their occurrence and misdiagnosis, as well as the main points of diagnosis and treatment to be discussed in order to arouse the same attention.1 typical cases Case 1: male, 76 years old, suffering from hypertension more than 10 years in February 1991 due to dry mouth, fatigue My courtyard clinic, check the blood glucose 20mmol / L, urine + +, diagnosis of non-insulin-dependent diabetes mellitus (NIDDM), giving glyburide 2.5mg, 2 times / day .2002 on February 10 playing mahjong 3 hours later Go to bed, was found in the early morning of the next morning unconsciousness, urinary incontinence and sent to the hospital emergency.Check: T36.5 ℃, P84 times / min, R2O times / min, BP22 / 12kPa. Was shallow coma, bilateral pupils and other large Other round, diameter 3.5mm, slow light reflex, left corner of the mouth, flow, pressure supraorbital nerve, right limb no activity, Pseudomonas syndrome suspicious diagnosis of cerebral thrombosis and diabetes .At that time, consider saline may aggravate cerebral edema 5% glucose water intravenous infusion, while 20% mannitol dehydration .3 hours later