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What is the Importance of Hypoglycemia Awareness in T1D Patients?Hypoglycemic unawareness prevention -
Key Messages Recommendations Figures Full Text References. Chapter Headings Introduction Definition and Frequency of Hypoglycemia Severe Hypoglycemia and Hypoglycemia Unawareness Complications of Severe Hypoglycemia Treatment of Hypoglycemia Other Relevant Guidelines Author Disclosures.
Key Messages It is important to prevent, recognize and treat hypoglycemic episodes secondary to the use of insulin or insulin secretagogues. It is safer and more effective to prevent hypoglycemia than to treat it after it occurs, so people with diabetes who are at high risk for hypoglycemia should be identified and counselled about ways to prevent low blood glucose.
It is important to counsel individuals who are at risk of hypoglycemia and their support persons about the recognition and treatment of hypoglycemia. The goals of treatment for hypoglycemia are to detect and treat a low blood glucose level promptly by using an intervention that provides the fastest rise in blood glucose to a safe level, to eliminate the risk of injury and to relieve symptoms quickly.
Once the hypoglycemia has been reversed, the person should have the usual meal or snack that is due at that time of the day to prevent repeated hypoglycemia.
It is important to avoid overtreatment of hypoglycemia, since this can result in rebound hyperglycemia and weight gain. Key Messages for People with Diabetes Know the signs and symptoms of a low blood glucose level.
Some of the more common symptoms of low blood glucose are trembling, sweating, anxiety, confusion, difficulty concentrating or nausea. Not all symptoms will be present and some individuals may have other or no symptoms.
Wear diabetes identification e. a MedicAlert® bracelet Talk with your diabetes health-care team about prevention and emergency treatment of a severe low blood glucose associated with confusion, loss of consciousness or seizure. Introduction Drug-induced hypoglycemia is a major obstacle for individuals trying to achieve glycemic targets.
Complications of Severe Hypoglycemia Short-term risks of hypoglycemia include the dangerous situations that can arise while an individual is hypoglycemic, whether at home or at work e.
Treatment of Hypoglycemia The goals of treatment for hypoglycemia are to detect and treat a low BG level promptly by using an intervention that provides the fastest rise in BG to a safe level, to eliminate the risk of injury and to relieve symptoms quickly.
Recommendations All people with diabetes currently using or starting therapy with insulin or insulin secretagogues and their support persons should be counselled about the risk, prevention, recognition and treatment of hypoglycemia. Risk factors for severe hypoglycemia should be identified and addressed [Grade D, Consensus].
The DHC team should review the person with diabetes' experience with hypoglycemia at each visit, including an estimate of cause, frequency, symptoms, recognition, severity and treatment, as well as the risk of driving with hypoglycemia [Grade D, Consensus]. In people with diabetes at increased risk of hypoglycemia, the following strategies may be used to reduce the risk of hypoglycemia: Avoidance of pharmacotherapies associated with increased risk of recurrent or severe hypoglycemia see Glycemic Management in Adults with Type 1 Diabetes, p.
S88, for further discussion of drug-induced hypoglycemia [Grade D, Consensus] A standardized education program targeting rigorous avoidance of hypoglycemia while maintaining overall glycemic control [Grade B, Level 2 83 ] Increased frequency of SMBG, including periodic assessment during sleeping hours [Grade D, Consensus] Less stringent glycemic targets with avoidance of hypoglycemia for up to 3 months [Grade D, Level 4 37,38 ] A psycho-behavioural intervention program blood glucose awareness training [Grade C, Level 3 40 ] Structured diabetes education and frequent follow up [Grade C, Level 3 42 for type 1 diabetes; Grade D, Consensus for type 2].
In people with diabetes with recurrent or severe hypoglycemia, or impaired awareness of hypoglycemia, the following strategies may be considered to reduce or eliminate the risk of severe hypoglycemia and to attempt to regain hypoglycemia awareness: Less stringent glycemic targets with avoidance of hypoglycemia for up to 3 months [Grade D, Level 4 37,38 ] CSII or CGM or sensor augmented pump with education and follow up for type 1 diabetes [Grade B, Level 2 42,44,46,47 ] Islet transplantation for type 1 diabetes [Grade C, Level 3 48 ] Pancreas transplantation for type 1 diabetes [Grade D, Level 4 50—53 ].
These are preferable to orange juice and glucose gels [Grade B, Level 2 73 ]. Note : This does not apply to children. See Type 1 Diabetes in Children and Adolescents, p. S; and Type 2 Diabetes in Children and Adolescents, p. S, for treatment options in children. For people with diabetes at risk of severe hypoglycemia, support persons should be taught how to administer glucagon [Grade D, Consensus].
Abbreviations: A1C , glycated hemoglobin; BG, blood glucose; CVD , cardiovascular disease; CGM , continuous glucose monitoring; CSII , continuous subcutaneous insulin infusion; DHC , diabetes health-care team; SMBG , self-monitoring of blood glucose.
Other Relevant Guidelines Chpater 8. Targets for Glycemic Control Chapter 9. Monitoring Glycemic Control Chapter Glycemic Management in Adults With Type 1 Diabetes Chapter Pharmacologic Glycemic Management of Type 2 Diabetes in Adults Chapter Diabetes and Driving Chapter Type 1 Diabetes in Children and Adolescents Chapter Type 2 Diabetes in Children and Adolescents Chapter Diabetes and Pregnancy Chapter Diabetes in Older People.
Author Disclosures Dr. References Alvarez-Guisasola F, Yin DD, Nocea G, et al. Health Qual Life Outcomes ; Anderbro T, Amsberg S, Adamson U, et al.
Fear of hypoglycaemia in adults with Type 1 diabetes. Diabet Med ;—8. Belendez M, Hernandez-Mijares A. Beliefs about insulin as a predictor of fear of hypoglycaemia. Chronic Illn ;—6. Barnard K, Thomas S, Royle P, et al. Fear of hypoglycaemia in parents of young children with type 1 diabetes: A systematic review.
BMC Pediatr ; Di Battista AM, Hart TA, Greco L, et al. Type 1 diabetes among adolescents: Reduced diabetes self-care caused by social fear and fear of hypoglycemia. Diabetes Educ ;— Haugstvedt A,Wentzel-Larsen T, GraueM, et al.
Fear of hypoglycaemia in mothers and fathers of children with type 1 diabetes is associated with poor glycaemic control and parental emotional distress: A population-based study. Hepburn DA.
Symptoms of hypoglycaemia. In: Frier BM, Fisher BM, eds. Hypoglycaemia and diabetes: clinical and physiological aspects. London: Edward Arnold, , pg. The Diabetes Control and Complications Trial Research Group.
Adverse events and their association with treatment regimens in the diabetes control and complications trial. Diabetes Care ;— Hypoglycemia in the diabetes control and complications trial.
Diabetes ;— Mühlhauser I, Overmann H, Bender R, et al. Risk factors of severe hypoglycaemia in adult patients with type I diabetes—a prospective population based study. Diabetologia ;— The DCCT Research Group. Epidemiology of severe hypoglycemia in the diabetes control and complications trial.
Am J Med ;—9. Davis EA, Keating B, Byrne GC, et al. Hypoglycemia: Incidence and clinical predictors in a large population-based sample of children and adolescents with IDDM. Diabetes Care ;—5. Egger M, Davey Smith G, Stettler C, et al. Risk of adverse effects of intensified treatment in insulin-dependent diabetes mellitus: A meta-analysis.
Diabet Med ;— Gold AE, MacLeod KM, Frier BM. Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia. Mokan M, Mitrakou A, Veneman T, et al. Hypoglycemia unawareness in IDDM.
Meyer C, Grossmann R, Mitrakou A, et al. Effects of autonomic neuropathy on counterregulation and awareness of hypoglycemia in type 1 diabetic patients. Diabetes Care ;—6. Diabetes Control and Complications Trial Research Group.
Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. J Pediatr ;— Miller ME, Bonds DE, Gerstein HC, et al. The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: Post hoc epidemiological analysis of the ACCORD study.
BMJ ;b de Galan BE, Zoungas S, Chalmers J, et al. Cognitive function and risks of cardiovascular disease and hypoglycaemia in patients with type 2 diabetes: The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation ADVANCE trial.
Sarkar U, Karter AJ, Liu JY, et al. Hypoglycemia is more common among type 2 diabetes patients with limited health literacy: The Diabetes Study of Northern California DISTANCE.
J Gen Intern Med ;—8. Seligman HK, Davis TC, Schillinger D, et al. Food insecurity is associated with hypoglycemia and poor diabetes self-management in a low-income sample with diabetes.
J Health Care Poor Underserved ;— Davis TM, Brown SG, Jacobs IG, et al. Determinants of severe hypoglycemia complicating type 2 diabetes: The Fremantle diabetes study.
J Clin Endocrinol Metab ;—7. Schopman JE, Geddes J, Frier BM. Prevalence of impaired awareness of hypoglycaemia and frequency of hypoglycaemia in insulin-treated type 2 diabetes. Diabetes Res Clin Pract ;—8. Cryer PE. Banting lecture. Hypoglycemia: The limiting factor in the management of IDDM.
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American Diabetes Association Workgroup on Hypoglycemia. Hypoglycemia in pregnant women with type 1 diabetes: predictors and role of metabolic control. Insulin overdose among patients with diabetes: a readily available means of suicide.
Blood Glucose Awareness Training: what is it, where is it, and where is it going? JDRF Continuous Glucose Monitoring Study Group. Factors predictive of severe hypoglycemia in type 1 diabetes: analysis from the Juvenile Diabetes Research Foundation's continuous glucose monitoring randomized, controlled trial dataset.
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Online ISSN Print ISSN Books ShopDiabetes. org ADA Professional Books Clinical Compendia Clinical Compendia Home News Latest News DiabetesPro SmartBrief. Together, you can review all your data to figure out the cause of the lows. The more information you can give your health care provider, the better they can work with you to understand what's causing the lows.
Your provider may be able to help prevent low blood glucose by adjusting the timing of insulin dosing, exercise, and meals or snacks. Changing insulin doses or the types of food you eat may also do the trick.
Breadcrumb Home Life with Diabetes Get the Right Care for You Hypoglycemia Low Blood Glucose. Low blood glucose may also be referred to as an insulin reaction, or insulin shock.
Signs and symptoms of low blood glucose happen quickly Each person's reaction to low blood glucose is different. Treatment—The " Rule" The rule—have 15 grams of carbohydrate to raise your blood glucose and check it after 15 minutes.
Note: Young children usually need less than 15 grams of carbs to fix a low blood glucose level: Infants may need 6 grams, toddlers may need 8 grams, and small children may need 10 grams.
This needs to be individualized for the patient, so discuss the amount needed with your diabetes team. When treating a low, the choice of carbohydrate source is important. Complex carbohydrates, or foods that contain fats along with carbs like chocolate can slow the absorption of glucose and should not be used to treat an emergency low.
Treating severe hypoglycemia Glucagon is a hormone produced in the pancreas that stimulates your liver to release stored glucose into your bloodstream when your blood glucose levels are too low. Steps for treating a person with symptoms keeping them from being able to treat themselves.
If the glucagon is injectable, inject it into the buttock, arm, or thigh, following the instructions in the kit. If your glucagon is inhalable, follow the instructions on the package to administer it into the nostril. When the person regains consciousness usually in 5—15 minutes , they may experience nausea and vomiting.
Do NOT: Inject insulin it will lower the person's blood glucose even more Provide food or fluids they can choke Causes of low blood glucose Low blood glucose is common for people with type 1 diabetes and can occur in people with type 2 diabetes taking insulin or certain medications.
Insulin Too much insulin is a definite cause of low blood glucose. Food What you eat can cause low blood glucose, including: Not enough carbohydrates. Eating foods with less carbohydrate than usual without reducing the amount of insulin taken.
Timing of insulin based on whether your carbs are from liquids versus solids can affect blood glucose levels. Liquids are absorbed much faster than solids, so timing the insulin dose to the absorption of glucose from foods can be tricky. The composition of the meal—how much fat, protein, and fiber are present—can also affect the absorption of carbohydrates.
Physical activity Exercise has many benefits. Medical IDs Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times. Hypoglycemia unawareness occurs more frequently in those who: Frequently have low blood glucose episodes which can cause you to stop sensing the early warning signs of hypoglycemia.
Have had diabetes for a long time. Tightly manage their diabetes which increases your chances of having low blood glucose reactions. How can I prevent low blood glucose? If you can, check often! Check before and after meals. Check before bed.
Unawarenesss the day, depending Hypoglycemic unawareness prevention multiple factors, blood glucose also called blood sugar levels will unwaareness or down. Unawarenfss is normal. But Gestational diabetes and gestational sleep disturbances it goes below the healthy range and is not treated, it can get dangerous. Low blood glucose is when your blood glucose levels have fallen low enough that you need to take action to bring them back to your target range. However, talk to your diabetes care team about your own blood glucose targets, and what level is too low for you. Unnawareness hypoglycemia is a major obstacle for individuals preventiion to unawarenezs glycemic Understanding hypertension risks. Hypoglycemia can be severe and Hypoglycemic unawareness prevention in nuawareness, coma or seizure, requiring the assistance of other individuals. Significant risk of hypoglycemia often necessitates less stringent glycemic goals. Frequency and severity of hypoglycemia negatively impact on quality of life 1 and promote fear of future hypoglycemia 2,3. This fear is associated with reduced self-care and poor glucose control 4—6.
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