Revisiting Hypoglycemia in Diabetes
Abstract
Hypoglycemia is a common and serious complication of diabetes management. There is no uniformly accepted clinical definition of hypoglycemia. The American Diabetes Association (ADA) recommends that people with diabetes consider treating hypoglycemia when the self-monitored blood glucose (SMBG) level is ≤70 mg/dl (3.9 mmol/L). Hypoglycemia significantly affects mortality and quality of life. Normally, in people without diabetes, hypoglycemia is prevented by redundant protective counter-regulatory mechanisms. These counter-regulatory pathways become defective in people with Type 1 diabetes and those with long standing Type 2 diabetes.
Most hypoglycemic episodes in diabetes are related to the use of insulin and insulin secretagogues. The National Electronic Injury Surveillance System study in older adults found that nearly 25% of all medication induced hospitalizations were due to insulin and oral hypoglycemic agents.
The treatment of hypoglycemia will depend on the severity of the event and symptoms. When the person is conscious and able to respond, a fast acting carbohydrate is the treatment of choice. The “rule of 15” is often recommended. Severe hypoglycemia that is associated with inability to help oneself should be treated with injectable glucagon.
This paper will review the typical signs and symptoms of hypoglycemia in diabetes, its pathophysiology, classification, prevention and treatment.
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Accepted 2014-01-16
Published 2014-01-01
