Contributor Disclosures. Please read the Disclaimer at the end of this page. Hypoglycemia is the medical term Dietary choices for strong bones low blood glucose blood sugar.
People with type 1 diabetes who Antioxidant-rich foods dauses to manage their blood glucose levels are at risk for getting hypoglycemia. The frequency of hypoglycemia among people with longstanding type 2 diabetes increases over time, as the body eventually stops making enough insulin.
The symptoms of low blood glucose vary from person to person and can change over unawarenfss. During csuses Antioxidant-rich foods stages of low blood glucose, you may:.
When possible, you should causee that you have hypoglycemia Antioxidant-rich foods measuring your blood glucose level see cakses education: Glucose monitoring in diabetes Beyond the Basics " :. You may need to take snd to ensure your Hyoglycemic and prevent your glucose level from getting even lower; these may include avoiding activities like driving as well as repeating the Hypoglycemic unawareness causes and symptoms measurement, Dietary restrictions in sports performance something with fast-acting carbohydrates, Cramp relief for dancers making adjustments to your diabetes czuses.
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Nocturnal hypoglycemia — Low blood Hypoglyceic that occurs when you are sleeping called nocturnal hypoglycemia can disrupt sleep but often goes unrecognized.
Nocturnal hypoglycemia is Hypotlycemic form Hypoglycmic hypoglycemia unawareness. Thus, if you have nocturnal hypoglycemia, you are less likely Prenatal and postnatal supplements have symptoms that alert you to the need for treatment.
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To prevent low blood glucose, it is important to monitor Hydration guidelines for seniors blood Results-driven weight loss supplements levels frequently and be prepared to treat it promptly at any time.
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Continuous symmptoms monitoring can alert you to a low or falling blood glucose level so that you can take Mushroom Cooking Techniques to avoid severe hypoglycemia.
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If you experience low blood glucose levels, let unawarreness health care provider know. They can help adjust dauses diabetes treatment plan to csuses the chances of hypoglycemia happening symptomss.
They can also talk to unawardness about blood glucose awareness education. Blood glucose awareness training can improve your ability to recognize low blood glucose earlier, which will allow you to treat it quickly and avoid more serious symptoms.
A trained diabetes educator can also work with you to help you anticipate when low glucose levels are more likely to happen.
Low blood glucose can be frightening and unpleasant. If you have experienced this before, you may be worried or anxious about the possibility of it happening again. However, it's important to talk to your health care provider and not just intentionally keep your blood glucose high because of this.
High blood glucose levels can lead to serious long-term complications. See "Patient education: Preventing complications from diabetes Beyond the Basics ".
The treatment of low blood glucose depends on whether you have symptoms and how severe the symptoms are. No symptoms — Your health care provider will talk to you about what to do if you check your blood glucose and it is low, but you have no noticeable symptoms. They might recommend checking your levels again after a short time, avoiding activities like driving, or eating something with carbohydrates.
Early symptoms — If you have early symptoms of low blood glucose, you should check your level as soon as possible. However, if your monitoring equipment is not readily available, you can go ahead and give yourself treatment.
It's important to treat low blood glucose as soon as possible. To treat low blood glucose, eat 15 grams of fast-acting carbohydrate. This amount of food is usually enough to raise your blood glucose into a safe range without causing it to get too high.
Avoid foods that contain fat like candy bars or protein such as cheese initially, since they slow down your body's ability to absorb glucose. Check your blood glucose again after 15 minutes and repeat treatment if your level is still low.
Monitor your blood glucose levels more frequently for the next few hours to ensure your blood glucose levels are not low. Severe symptoms — If your blood glucose is very low, you may pass out or become too disoriented to eat. A close friend or relative should be trained to recognize severe low blood glucose and treat it quickly.
Dealing with a loved one who is pale, sweaty, acting bizarrely, or passed out and convulsing can be scary. A dose of glucagon stops these symptoms quickly if they are caused by hypoglycemia.
Glucagon is a hormone that raises blood glucose levels. Glucagon is available in emergency kits as an injection or a nasal spraywhich can be bought with a prescription in a pharmacy.
Directions are included in each kit; a roommate, partner, parent, or friend should learn how to give glucagon before an emergency occurs. It is important that your glucagon kit is easy to locate, is not expired, and that the friend or relative is able to stay calm.
You should refill the kit when the expiration date approaches, although using an expired kit is unlikely to cause harm. This releases the powder into the person's nostril without requiring them to inhale or do anything else. If you have to give another person glucagon, turn them onto their side afterwards.
This prevents choking if they vomit, which sometimes happens. Low blood glucose symptoms should resolve within 10 to 15 minutes after a dose of glucagon, although nausea and vomiting may follow 60 to 90 minutes later.
As soon as the person is awake and able to swallow, offer a fast-acting carbohydrate such as glucose tablets or juice. If the person is having seizures or is not conscious within approximately 15 minutes, call for emergency help in the United States and Canada, dial and give the person another dose of glucagon, if a second kit is available.
FOLLOW-UP CARE. After your blood glucose level normalizes and your symptoms are gone, you can usually resume your normal activities.
If you required glucagon, you should call your health care provider right away. They can help you to determine how and why you developed severely low blood glucose and can suggest adjustments to prevent future reactions.
In the first 48 to 72 hours after a low blood glucose episode, you may have difficulty recognizing the symptoms of low blood glucose. In addition, your body's ability to counteract low blood glucose levels is decreased. Check your blood glucose level before you eat, exercise, or drive to avoid another low blood glucose episode.
WHEN TO SEEK HELP. A family member or friend should take you to the hospital or call for emergency assistance immediately if you:. Once in a hospital or ambulance, you will be given treatment intravenously by IV to raise your blood glucose level immediately.
If you require emergency care, you may be observed in the emergency department for a few hours before being released. In this situation, you will need someone else to drive you home. Your health care provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our website www. Related topics for patients, as well as selected articles written for health care professionals, are also available.
Some of the most relevant are listed below. Patient level information — UpToDate offers two types of patient education materials. The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition.
These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Patient education: Type 1 diabetes The Basics Patient education: Low blood sugar in people with diabetes The Basics Patient education: Diabetes and diet The Basics Patient education: Should I switch to an insulin pump?
The Basics. Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Type 1 diabetes: Insulin treatment Beyond the Basics Patient education: Type 1 diabetes: Overview Beyond the Basics Patient education: Exercise and medical care for people with type 2 diabetes Beyond the Basics Patient education: Type 2 diabetes: Overview Beyond the Basics Patient education: Type 2 diabetes: Treatment Beyond the Basics Patient education: Preventing complications from diabetes Beyond the Basics Patient education: Glucose monitoring in diabetes Beyond the Basics.
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings.
These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Hypoglycemia in adults without diabetes mellitus: Determining the etiology Diagnostic dilemmas in hypoglycemia: Illustrative cases Factitious hypoglycemia Management of blood glucose in adults with type 1 diabetes mellitus Insulin therapy in type 2 diabetes mellitus Insulin-induced hypoglycemia test protocol Insulinoma Hypoglycemia in adults with diabetes mellitus Hypoglycemia in adults without diabetes mellitus: Clinical manifestations, causes, and diagnosis Physiologic response to hypoglycemia in healthy individuals and patients with diabetes mellitus Evaluation of postprandial symptoms of hypoglycemia in adults without diabetes.
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Patient education: Hypoglycemia low blood glucose in people with diabetes Beyond the Basics.
: Hypoglycemic unawareness causes and symptoms| Background | Avoid foods that contain fat like candy bars or protein such as cheese initially, since they slow down your body's ability to absorb glucose. Check your blood glucose again after 15 minutes and repeat treatment if your level is still low. Monitor your blood glucose levels more frequently for the next few hours to ensure your blood glucose levels are not low. Severe symptoms — If your blood glucose is very low, you may pass out or become too disoriented to eat. A close friend or relative should be trained to recognize severe low blood glucose and treat it quickly. Dealing with a loved one who is pale, sweaty, acting bizarrely, or passed out and convulsing can be scary. A dose of glucagon stops these symptoms quickly if they are caused by hypoglycemia. Glucagon is a hormone that raises blood glucose levels. Glucagon is available in emergency kits as an injection or a nasal spray , which can be bought with a prescription in a pharmacy. Directions are included in each kit; a roommate, partner, parent, or friend should learn how to give glucagon before an emergency occurs. It is important that your glucagon kit is easy to locate, is not expired, and that the friend or relative is able to stay calm. You should refill the kit when the expiration date approaches, although using an expired kit is unlikely to cause harm. This releases the powder into the person's nostril without requiring them to inhale or do anything else. If you have to give another person glucagon, turn them onto their side afterwards. This prevents choking if they vomit, which sometimes happens. Low blood glucose symptoms should resolve within 10 to 15 minutes after a dose of glucagon, although nausea and vomiting may follow 60 to 90 minutes later. As soon as the person is awake and able to swallow, offer a fast-acting carbohydrate such as glucose tablets or juice. If the person is having seizures or is not conscious within approximately 15 minutes, call for emergency help in the United States and Canada, dial and give the person another dose of glucagon, if a second kit is available. FOLLOW-UP CARE. After your blood glucose level normalizes and your symptoms are gone, you can usually resume your normal activities. If you required glucagon, you should call your health care provider right away. They can help you to determine how and why you developed severely low blood glucose and can suggest adjustments to prevent future reactions. In the first 48 to 72 hours after a low blood glucose episode, you may have difficulty recognizing the symptoms of low blood glucose. In addition, your body's ability to counteract low blood glucose levels is decreased. Check your blood glucose level before you eat, exercise, or drive to avoid another low blood glucose episode. WHEN TO SEEK HELP. A family member or friend should take you to the hospital or call for emergency assistance immediately if you:. Once in a hospital or ambulance, you will be given treatment intravenously by IV to raise your blood glucose level immediately. If you require emergency care, you may be observed in the emergency department for a few hours before being released. In this situation, you will need someone else to drive you home. Your health care provider is the best source of information for questions and concerns related to your medical problem. This article will be updated as needed on our website www. Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below. Patient level information — UpToDate offers two types of patient education materials. The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Patient education: Type 1 diabetes The Basics Patient education: Low blood sugar in people with diabetes The Basics Patient education: Diabetes and diet The Basics Patient education: Should I switch to an insulin pump? The Basics. Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon. Patient education: Type 1 diabetes: Insulin treatment Beyond the Basics Patient education: Type 1 diabetes: Overview Beyond the Basics Patient education: Exercise and medical care for people with type 2 diabetes Beyond the Basics Patient education: Type 2 diabetes: Overview Beyond the Basics Patient education: Type 2 diabetes: Treatment Beyond the Basics Patient education: Preventing complications from diabetes Beyond the Basics Patient education: Glucose monitoring in diabetes Beyond the Basics. Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading. 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. Daneman D, Frank M, Perlman K, et al. Severe hypoglycemia in children with insulin-dependent diabetes mellitus: Frequency and predisposing factors. J Pediatr ;—5. Berlin I, Sachon CI, Grimaldi A. Identification of factors associated with impaired hypoglycaemia awareness in patients with type 1 and type 2 diabetes mellitus. Diabetes Metab ;— Schultes B, Jauch-Chara K, Gais S, et al. Defective awakening response to nocturnal hypoglycemia in patients with type 1 diabetes mellitus. PLoS Med ;4:e Porter PA, Byrne G, Stick S, et al. Nocturnal hypoglycaemia and sleep disturbances in young teenagers with insulin dependent diabetes mellitus. Arch Dis Child ;—3. Gale EA, Tattersall RB. Unrecognised nocturnal hypoglycaemia in insulintreated diabetics. Lancet ;— Beregszàszi M, Tubiana-Rufi N, Benali K, et al. Nocturnal hypoglycemia in children and adolescents with insulin-dependent diabetes mellitus: Prevalence and risk factors. Vervoort G, Goldschmidt HM, van Doorn LG. Diabet Med ;—9. Ovalle F, Fanelli CG, Paramore DS, et al. Brief twice-weekly episodes of hypoglycemia reduce detection of clinical hypoglycemia in type 1 diabetes mellitus. Diabetes ;—9. Fanelli CG, Epifano L, Rambotti AM, et al. Meticulous prevention of hypoglycemia normalizes the glycemic thresholds and magnitude of most of neuroendocrine responses to, symptoms of, and cognitive function during hypoglycemia in intensively treated patients with short-term IDDM. Dagogo-Jack S, Rattarasarn C, Cryer PE. Reversal of hypoglycemia unawareness, but not defective glucose counterregulation, in IDDM. Fanelli C, Pampanelli S, Epifano L, et al. Long-term recovery from unawareness, deficient counterregulation and lack of cognitive dysfunction during hypoglycaemia, following institution of rational, intensive insulin therapy in IDDM. Dagogo-Jack S, Fanelli CG, Cryer PE. Durable reversal of hypoglycemia unawareness in type 1 diabetes. Diabetes Care ;—7. Davis M, Mellman M, Friedman S, et al. Recovery of epinephrine response but not hypoglycemic symptomthreshold after intensive therapy in type 1 diabetes. Am J Med ;— Liu D, McManus RM, Ryan EA. Improved counter-regulatory hormonal and symptomatic responses to hypoglycemia in patients with insulin-dependent diabetes mellitus after 3 months of less strict glycemic control. Clin Invest Med ;— Lingenfelser T, Buettner U, Martin J, et al. Improvement of impaired counterregulatory hormone response and symptom perception by short-term avoidance of hypoglycemia in IDDM. Kinsley BT,Weinger K, Bajaj M, et al. Blood glucose awareness training and epinephrine responses to hypoglycemia during intensive treatment in type 1 diabetes. Diabetes Care ;—8. Schachinger H, Hegar K, Hermanns N, et al. Randomized controlled clinical trial of Blood Glucose Awareness Training BGAT III in Switzerland and Germany. J Behav Med ;— Yeoh E, Choudhary P, Nwokolo M, et al. Interventions that restore awareness of hypoglycemia in adults with type 1 diabetes: A systematic review and metaanalysis. van Dellen D, Worthington J, Mitu-Pretorian OM, et al. Mortality in diabetes: Pancreas transplantation is associated with significant survival benefit. Nephrol Dial Transplant ;— Ly TT, Nicholas JA, Retterath A, et al. Effect of sensor-augmented insulin pump therapy and automated insulin suspension vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes: A randomized clinical trial. JAMA ;—7. Little SA, Leelarathna L,Walkinshaw E, et al. Recovery of hypoglycemia awareness in long-standing type 1 diabetes: A multicenter 2 x 2 factorial randomized controlled trial comparing insulin pump with multiple daily injections and continuous with conventional glucose self-monitoring HypoCOMPaSS. Bergenstal RM, Klonoff DC, Garg SK, et al. Threshold-based insulin-pump interruption for reduction of hypoglycemia. N Engl J Med ;— van Beers CAJ, DeVries JH, Kleijer SJ, et al. Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia IN CONTROL : A randomised, open-label, crossover trial. Lancet Diabetes Endocrinol ;— Hering BJ, Clarke WR, Bridges ND, et al. Phase 3 trial of transplantation of human islets in type 1 diabetes complicated by severe hypoglycemia. Rickels MR. Recovery of endocrine function after islet and pancreas transplantation. Curr Diab Rep ;— Moassesfar S, Masharani U, Frassetto LA, et al. A comparative analysis of the safety, efficacy, and cost of islet versus pancreas transplantation in nonuremic patients with type 1 diabetes. Am J Transplant ;— Kendall DM, Rooney DP, Smets YF, et al. Pancreas transplantation restores epinephrine response and symptom recognition during hypoglycemia in patients with long-standing type I diabetes and autonomic neuropathy. Paty BW, Lanz K, Kendall DM, et al. Restored hypoglycemic counterregulation is stable in successful pancreas transplant recipients for up to 19 years after transplantation. Transplantation ;—7. Barrou Z, Seaquist ER, Robertson RP. Pancreas transplantation in diabetic humans normalizes hepatic glucose production during hypoglycemia. Diabetes ;—6. Davis SN, Mann S, Briscoe VJ, et al. Effects of intensive therapy and antecedent hypoglycemia on counterregulatory responses to hypoglycemia in type 2 diabetes. Diabetes Research in Children Network DirecNet Study Group, Tsalikian E, Tamborlane W, et al. Blunted counterregulatory hormone responses to hypoglycemia in young children and adolescents with well-controlled type 1 diabetes. Diabetes Care ;—9. Bruce DG, DavisWA, Casey GP, et al. Severe hypoglycaemia and cognitive impairment in older patients with diabetes: The Fremantle Diabetes Study. Zhang Z, Lovato J, Battapady H, et al. Effects of intensive diabetes therapy on neuropsychological function in adults in the Diabetes Control and Complications Trial. Ann Intern Med ;— Reichard P, Pihl M. Mortality and treatment side-effects during long-term intensified conventional insulin treatment in the Stockholm Diabetes Intervention Study. Long-term effect of diabetes and its treatment on cognitive function. Brands AM, Biessels GJ, de Haan EH, et al. The effects of type 1 diabetes on cognitive performance: A meta-analysis. Hayward RA, Reaven PD, Wiitala WL, et al. Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes. Hypoglycemia is the medical term for low blood sugar low blood glucose. Your body, especially your brain, depends on this sugar to work. Too little sugar in your blood causes problems that can sometimes be serious. Hypoglycemia is common in people with type 1 diabetes T1D. In fact, most people with T1D experience at least 1 or 2 episodes of mild hypoglycemia a week. This leads to low blood sugar. The more time you spend in this range, the less likely you are to develop complications from diabetes. Some causes of hypoglycemia are things that you can control or prevent, but other causes are things you cannot control. The first signs of hypoglycemia include feeling sweaty, shaky, and hungry. However, not everyone has these symptoms or notices them in time to prevent low blood sugar from getting worse. Severe hypoglycemia may make you faint or pass out. This is dangerous if you are driving, climbing stairs, or doing other activities where you need to stay aware of things around you. Hypoglycemia can happen at night. A continuous glucose monitor, or CGM, can alert you and those around you with an alarm to let you know if your blood sugar starts getting low while you are sleeping. Your CGM can also let you know when your blood sugar is getting lower. You might not have early warning signs of low blood sugar. It is more likely if:. If you start feeling any of the symptoms listed above, check your blood sugar as soon as possible, then follow the chart below to treat low blood sugar. Eat 20 to 30 grams of fast-acting carbs, such as 8 ounces of fruit juice, 12 to 16 hard candies, or 6 to 8 glucose tablets. If you start feeling confused or disoriented or have trouble walking or seeing, you may have very low blood sugar. You may also need help to treat a severe low, if your symptoms are so bad that you cannot think clearly or stay focused. It is important that friends, family, teachers, coaches, and other people who may be in a position to help you in the case of a severe low learn how to test your blood glucose and use glucagon BEFORE the need arises. That way they will be best prepared to help you quickly during an episode of severe hypoglycemia. In an emergency, a medical identification bracelet or necklace and carrying glucagon could make a dramatic difference in keeping you safe and healthy. Even if you wear a pump or CGM, emergency medical technicians EMTs are trained to look for medical identification. To treat severe hypoglycemia, you need to have someone administer glucagon via syringe, nasal spray, or auto-injector pen. The person with you should help you lie on your side to recover. |
| Hypoglycemia unawareness | If you have needed glucagon, let your doctor know so you can discuss ways to prevent severe hypoglycemia in the future. If someone is unconscious and glucagon is not available or someone does not know how to use it, call immediately. 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. If you add in lows without symptoms and the ones that happen overnight, the number would likely be higher. Too much insulin is a definite cause of low blood glucose. Insulin pumps may also reduce the risk for low blood glucose. Accidentally injecting the wrong insulin type, too much insulin, or injecting directly into the muscle instead of just under the skin , can cause low blood glucose. Exercise has many benefits. The tricky thing for people with type 1 diabetes is that it can lower blood glucose in both the short and long-term. Nearly half of children in a type 1 diabetes study who exercised an hour during the day experienced a low blood glucose reaction overnight. The intensity, duration, and timing of exercise can all affect the risk for going low. Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times. In the event of a severe hypoglycemic episode, a car accident or other emergency, the medical ID can provide critical information about the person's health status, such as the fact that they have diabetes, whether or not they use insulin, whether they have any allergies, etc. Emergency medical personnel are trained to look for a medical ID when they are caring for someone who can't speak for themselves. Medical IDs are usually worn as a bracelet or a necklace. Traditional IDs are etched with basic, key health information about the person, and some IDs now include compact USB drives that can carry a person's full medical record for use in an emergency. As unpleasant as they may be, the symptoms of low blood glucose are useful. These symptoms tell you that you your blood glucose is low and you need to take action to bring it back into a safe range. But, many people have blood glucose readings below this level and feel no symptoms. This is called hypoglycemia unawareness. Hypoglycemia unawareness puts the person at increased risk for severe low blood glucose reactions when they need someone to help them recover. People with hypoglycemia unawareness are also less likely to be awakened from sleep when hypoglycemia occurs at night. People with hypoglycemia unawareness need to take extra care to check blood glucose frequently. This is especially important prior to and during critical tasks such as driving. A continuous glucose monitor CGM can sound an alarm when blood glucose levels are low or start to fall. This can be a big help for people with hypoglycemia unawareness. If you think you have hypoglycemia unawareness, speak with your health care provider. This helps your body re-learn how to react to low blood glucose levels. This may mean increasing your target blood glucose level a new target that needs to be worked out with your diabetes care team. It may even result in a higher A1C level, but regaining the ability to feel symptoms of lows is worth the temporary rise in blood glucose levels. This can happen when your blood glucose levels are very high and start to go down quickly. If this is happening, discuss treatment with your diabetes care team. Your best bet is to practice good diabetes management and learn to detect hypoglycemia so you can treat it early—before it gets worse. Monitoring blood glucose, with either a meter or a CGM, is the tried and true method for preventing hypoglycemia. Studies consistently show that the more a person checks blood glucose, the lower his or her risk of hypoglycemia. This is because you can see when blood glucose levels are dropping and can treat it before it gets too low. 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. Carmine Fanelli and other researchers reduced the frequency of hypoglycemia in people who had had diabetes for seven years or less but who suffered from hypoglycemia unawareness. As the higher premeal blood sugar target led to less hypoglycemia, people once again regained their low blood sugar symptoms. The counter-regulatory hormone response that alerts people to the presence of a low blood sugar returned to nearly normal after a few weeks of less frequent lows. Avoidance of lows enables people with diabetes to regain their symptoms when they become low. To reverse hypoglycemia unawareness, set your blood sugar targets higher, carefully adjust insulin doses to closely match your diet and exercise, and stay more alert to physical warnings for 48 hours following a first low blood sugar. Use your records to predict when lows are likely to occur. You might also consider using prescription medication like Precose acarbose or Glyset miglitol , which delay the absorption of carbohydrates. This has been shown to reduce the risk of low blood sugars. Use of Precose or Glyset can be combined with a modest reduction in carb boluses to lessen insulin activity over the length of time in which carbs are digested. Be quick to recognize problems that arise from stress, depression, or other self-care causes. For people with a physically active lifestyle, less insulin is needed during and for several hours after increased activity. An occasional 2 a. blood test can do wonders in preventing unrecognized nighttime lows. Using a continuous monitor or Sleep Sentry can alert you and your health care team to occurrences of unrecognized hypoglycemia. Once these devices warn of nighttime lows, insulin doses can be changed rapidly to stop the lows. As continuous monitoring devices become available, they should prevent most episodes of hypoglycemia entirely. Even short-term use of one of these devices may be able to break the cycle of lows through more appropriate insulin doses. Call your doctor immediately if you require assistance from others to recover from a severe low, whether it occurs during the day or at night. You want guidance because it is very likely to happen again. Discuss how to immediately reduce your insulin doses. For severe low blood sugar, injected glucagon is the best treatment. Glucagon, a hormone made by the alpha cells in the pancreas, rapidly raises blood sugar by triggering a release of glucose from glycogen stores in the liver. Injected glucagon is the fastest way to raise low blood sugar, but it requires that an injection be given by someone who has been trained to mix and inject it at the time it is needed. When someone with diabetes resists treatment, becomes unconscious, or has seizures due to hypoglycemia, glucagon can be injected by another person to rapidly raise the blood sugar. It is also handy for self-injection when someone with diabetes is ill or nauseated and cannot eat to correct low blood sugar. Glucagon kits are available by prescription and should be kept at home by everyone who uses insulin. The kit can be stored at room temperature or in the refrigerator and is stable for several years after purchase. Dating should be checked periodically to ensure potency. Instructions on how to prepare and inject glucagon should be provided to the person who has diabetes and to the person who is likely to be given the injection. A diabetes educator, trained nurse, or pharmacist can show how to inject glucagon. The typical dose in a glucagon kit is 1 milligram, which is sufficient to dose a lb. A full dose may cause nausea in a child or small adult and is often more than is needed for those who weigh less than lbs. If you are ever unable to handle a low blood sugar by yourself, lose consciousness, or suffer convulsions, notify your physician as soon as possible afterward. Events like this usually indicate that a major reduction in insulin doses is needed. Discuss the situation openly with your physician to prevent a reoccurrence. Adapted from Using Insulin © Walsh, Roberts, Varma, Bailey. Diabetes Response Service — the only scheduled proactive self-management Personal Call System using live operators to monitor, alert and prevent severe diabetic hypoglycemia. Type 1 Diabetes Type 1. Covid — A Special Threat with Diabetes Control Better Record Keeping Rules For Blood Glucose Control Carb Factor — The 2. |
| How Hypoglycemia Unawareness Affects People with Diabetes - Blog - NIDDK | J Hypoglycwmic Sci Technol. She was Dietary choices for strong bones by a neurologist in the morning for her focal neurological symptoms, and Hypgolycemic examination Heightens mental resilience no Hypooglycemic. Author: Unwwareness Antioxidant-rich foods Medical Review: E. Standards of medical Hypoglycemic unawareness causes and symptoms in diabetes — Other possible causes, in the present case, are due to increased physical activity following work shifts [ 126811 ]. Key Messages It is important to prevent, recognize and treat hypoglycemic episodes secondary to the use of insulin or insulin secretagogues. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. |
| Diabetes Canada | Clinical Practice Guidelines | Physiologic response to hypoglycemia in normal subjects and patients with diabetes mellitus. Up to Date Medical , Becker K. Endocrine drugs and values. Principles and practice of endocrinology and metabolism. Philadelphia: JB Lippincott; Hypoglycemia in the diabetes control and complications trial. Diamond MP, Reece EA, Caprio S, Jones TW, Amiel S, DeGennaro N, et al. Impairment of counterregulatory hormone responses to hypoglycemia in pregnant women with insulin-dependent diabetes mellitus. Am J Obstet Gynecol. Nakhjavani M, Esteghamati A, Emami F, Hoseinzadeh M. Iran J Endocrinol Metabol. Holleman F, Schmitt H, Rottiers R, Rees A, Symanowski S, Anderson JH, et al. Reduced frequency of severe hypoglycemia and coma in well-controlled IDDM patients treated with insulin lispro. Brunelle RL, Llewelyn J, Anderson JH Jr, Gale EA, Koivisto VA. Meta-analysis of the effect of insulin lispro on severe hypoglycemia in patients with type 1 diabetes. Anderson JH Jr, Brunelle RL, Koivisto VA, Pfützner A, Trautmann ME, Vignati L, et al. Reduction of postprandial hyperglycemia and frequency of hypoglycemia in IDDM patients on insulin-analog treatment. Monami M, Marchionni N, Mannucci E. Long-acting insulin analogues versus NPH human insulin in type 2 diabetes: a meta-analysis. Diabetes Res Clin Pract. Smith CB, Choudhary P, Pernet A, Hopkins D, Amiel SA. Hypoglycemia unawareness is associated with reduced adherence to therapeutic decisions in patients with type 1 diabetes: evidence from a clinical audit. Cranston I, Lomas J, Amiel SA, Maran A, Macdonald I. Restoration of hypoglycaemia awareness in patients with long-duration insulin-dependent diabetes. Battelino T, et al. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Wolpert HA. Use of continuous glucose monitoring in the detection and prevention of hypoglycemia. J Diabetes Sci Technol. Fritsche A, Stumvoll M, Häring HU, Gerich JE. Reversal of hypoglycemia unawareness in a long-term type 1 diabetic patient by improvement of β-adrenergic sensitivity after prevention of hypoglycemia. J Clin Endocrinol Metab. Hypoglycemia-associated autonomic failure in diabetes. Am J Physiol Endocrinol Metabol. Fanelli CG, et al. Meticulous prevention of hypoglycemia normalizes the glycemic thresholds and magnitude of most of neuroendocrine responses to, symptoms of, and cognitive function during hypoglycemia in intensively treated patients with short-term IDDM. Dagogo-Jack S, Rattarasarn C, Cryer PE. Reversal of hypoglycemia unawareness, but not defective glucose counterregulation, in IDDM. Download references. In appreciation, we express our gratitude to Dr. Rafiee for sharing the patient history and encouraging us to share this case as a valuable subject for other physicians. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, First Floor, No 10, Jalal-Al-Ahmad Street, North Kargar Avenue, Tehran, , Iran. Radiology Department, Iran University of Medical Sciences, Tehran, Iran. Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Tehran University of Medical Sciences, Tehran, Iran. You can also search for this author in PubMed Google Scholar. YSH: Study conception and design, data collection, and draft manuscript preparation. ME, SST: Draft of manuscript. All authors reviewed the results and read and approved the final manuscript. Correspondence to Yasaman Sharifi. Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of the Journal of Medical Case Reports. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is licensed under a Creative Commons Attribution 4. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and permissions. Sharifi, Y. Hypoglycemic unawareness: challenges, triggers, and recommendations in patients with hypoglycemic unawareness: a case report. J Med Case Reports 16 , Download citation. Received : 14 January Accepted : 14 June Published : 21 July Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background Hypoglycemia is a fairly common complication in diabetic patients, particularly in those on insulin therapy. Case presentation A year-old Iranian woman with HU presented with a severe hypoglycemic episode. Conclusions Hypoglycemia is a common complication in diabetic patients receiving oral or insulin therapy. Background Hypoglycemia is a relatively common complication in diabetic patients, particularly those on insulin therapy [ 1 ]. Case presentation A year-old Iranian woman weight: 57 kg; body mass index: Table 1 Results of the blood examination on first admission Full size table. Discussion Hypoglycemia is a common side effect of various diabetes medications, such as insulin and sulfonylureas [ 8 , 11 ]. The causes of hypoglycemia in people with diabetes, include: 1. Conclusions and learning points Hypoglycemia is a fairly common complication in diabetic patients receiving oral or insulin therapy. Availability of data and materials Patient data and information can be accessed for review after obtaining permission from the patient without any disclosure of her name. References Cryer PE, Davis SN, Shamoon H. Article CAS Google Scholar Cryer PE. Article CAS Google Scholar Hoeldtke RD, Boden G. Article CAS Google Scholar Greenspan SL, Resnick MN. Article CAS Google Scholar Wilson JD, Foster DW, Kronenberg HM, Larsen PR. Google Scholar Veneman T, Mitrakou A, Mokan M, Cryer P, Gerich J. Article CAS Google Scholar Kalra S, Mukherjee JJ, Venkataraman S, Bantwal G, Shaikh S, Saboo B, et al. Article Google Scholar Cryer P. Chapter Google Scholar Liu J, Wang R, Ganz ML, Paprocki Y, Schneider D, Weatherall J. Article CAS Google Scholar Whipple AO. Google Scholar American Diabetes Association. Article Google Scholar Amiel SA, Choudhary P, Jacob P, Smith EL, De Zoysa N, Gonder-Frederick L, et al. For example, people who have an episode of severe hypoglycemia are at a greater risk of having a heart attack or a stroke in the next year. It is not clear if this is only because of the hypoglycemia, or if these are just very frail people. Health care professionals should keep this in mind and pay close attention to other risk factors for cardiovascular disease in these patients, such as hypertension and high cholesterol. Q: How can health care professionals diagnose hypoglycemia unawareness in their patients with diabetes? A: Health care professionals should talk to their patients about hypoglycemia at every visit, and they should ask their patients how low their blood sugar has to go before they have symptoms. This should prompt the health care professional to think about why the patient is experiencing episodes of hypoglycemia. Is the patient using too much insulin? Is the patient skipping meals? Has the patient changed their physical activity level? This also reminds us that these patients should carry glucagon with them, and someone—a family member, coworker, or teacher—should know how to access and administer it. Q: How can health care professionals help patients manage hypoglycemia unawareness? A: Continuous glucose monitors are very good tools for patients that are at risk of hypoglycemia unawareness, because the CGM will alert them if their blood glucose level gets too low. Patients also will know what their blood glucose level is before they drive, and have insights into how food and exercise affect their glycemia. Health care professionals should also make sure that patients understand that they need to be aware of some circumstances that may put them at risk. The same is true for alcohol—if patients drink alcohol, it increases the risk of hypoglycemia, so they should be reminded to eat food if they are going to drink. Some studies have shown that if patients avoid hypoglycemia for some time, they can begin to feel the symptoms of hypoglycemia again. I have seen this in people with diabetes that participate in my research studies. By preventing hypoglycemia, you can reset the body to respond differently to symptoms of hypoglycemia. Some health care professionals may prefer to use newer basal insulins in patients at risk of hypoglycemia because these insulins seem to have less risk of hypoglycemia than the older ones, but they can still cause hypoglycemia, and we need to be aware of that. I think that for many people, it is easier to administer mealtime insulin when they have an insulin pump. It is also important to remember that some patients may be afraid to report episodes of hypoglycemia to their doctors because of legal implications. For example, some states may require people with diabetes to not have a hypoglycemia episode for 6 to 12 months before they can drive a vehicle. Health care professionals should emphasize to patients that they should know what their blood glucose level is before they drive a car, and that they should have food on hand, so if their glucose level drops, they can manage it. Q: What research is being conducted on hypoglycemia unawareness? A: Researchers are interested in different aspects of hypoglycemia unawareness such as the cause, complications, and treatments. Some groups are studying why recurrent hypoglycemia leads to impaired awareness. Is it a problem with brain adaptation to hypoglycemia, or is it only a problem with people who have severe glucagon deficiency? Other groups are doing research on the long-term effects of recurrent hypoglycemia on the function of other organs. I just finished a study where we gave people naloxone during an episode of exercise to determine if they recognize their hypoglycemia the next day, but the study was just completed, so we do not have results yet. We welcome comments; all comments must follow our comment policy. Blog posts written by individuals from outside the government may be owned by the writer and graphics may be owned by their creator. In such cases, it is necessary to contact the writer, artist, or publisher to obtain permission for reuse. You should start feeling better 10 to 15 minutes after a glucagon dose. If not, you need another dose. The emergency medical technicians can give you IV sugar into your vein. This raises your blood sugar level right away. You might need to stay in the hospital for a few hours. Use the table above to guide your treatment and timing instead of eating until you feel better, which will almost always lead to eating too much. Hypoglycemia can be common with certain types of exercise. Managing blood sugar during and after physical activity is important and is something that a lot of people with T1D have questions about. JDRF has a number of resources available for people with T1D and their families, many of which can be found here. After you treat your hypoglycemia and your blood sugar is back in its normal range, you may return to normal activities. If you needed glucagon, you should call your doctor. They need to know you had a severe low. They might also want to change your diabetes plan to avoid more severe lows or discuss using an insulin pump with a CGM to improve control of your blood sugar levels. CGM devices are extremely useful for avoiding and detecting hypoglycemia. After a low blood sugar episode, you are less sensitive to the early symptoms of hypoglycemia for 48 to 72 hours. This makes you more likely to have another episode. Check your blood sugar regularly, especially before eating, exercising, or driving a car. Several insulin pumps are now available that make managing blood sugar levels easier, particularly when connected to a glucose meter or a CGM. Some of the most important advantages of CGM devices are the improved insulin control and therefore fewer lows and the ability to detect trends and lows early. Resources that provide people with T1D and their families with more detailed information about pumps and CGM devices are available through JDRF here. For people looking for a deeper understanding of technology that helps people with T1D better manage their blood sugar, JDRF resources are available here. Children with T1D can get hypoglycemia for the same reasons as adults. They might get too much insulin for the amount of carbs they eat. They might skip a meal, eat different foods, or exercise harder than normal. Or, a parent or caregiver might give the wrong dose or type of insulin. Sometimes parents worry that hypoglycemia in children could lead to long-term brain damage, but doctors do not believe that this will happen. You can create a diabetes emergency kit for your child and make a low blood sugar plan with their school or daycare. |
| Hypoglycemia-Signs, Symptoms & Treatment |ADA | Article CAS Google Scholar. Cryer PE. Symptoms of hypoglycemia, thresholds for their occurrence, and hypoglycemia unawareness. Endocrinol Metab Clin North Am. Hoeldtke RD, Boden G. Epinephrine secretion, hypoglycemia unawareness, and diabetic autonomic neuropathy. Ann Intern Med. Greenspan SL, Resnick MN. Geriatric endocrinology. In: Greenspan FS, Strewler GJ, editors. Basic and clinical endocrinology. Stamford: Appleton and Lange; Mitrakou A, Ryan C, Veneman T, Mokan M, Jenssen T, Kiss I, et al. Hierarchy of glycemic thresholds for counterregulatory hormone secretion, symptoms, and cerebral dysfunction. Am J Physiol-Endocrinol Metabol. Wilson JD, Foster DW, Kronenberg HM, Larsen PR. The anterior pituitary. Williams textbook of endocrinology. Philadelphia: WB Saunders Co; Joslin EP, Kahn CR. Ronald Kahn Hypoglycemia: pathophysiology, diagnosis, and treatment. Oxford:: Oxford University Press; Google Scholar. Veneman T, Mitrakou A, Mokan M, Cryer P, Gerich J. Induction of hypoglycemia unawareness by asymptomatic nocturnal hypoglycemia. Kalra S, Mukherjee JJ, Venkataraman S, Bantwal G, Shaikh S, Saboo B, et al. Hypoglycemia: the neglected complication. Indian J Endocrinol Metabol. Article Google Scholar. Cryer P. Hypoglycemia in diabetes: pathophysiology, prevalence, and prevention. Arlington County: American Diabetes Association; In: Loriaux L, Vanek C, editors. Endocrine emergencies: recognition and treatment. Cham: Springer International Publishing; Chapter Google Scholar. Liu J, Wang R, Ganz ML, Paprocki Y, Schneider D, Weatherall J. The burden of severe hypoglycemia in type 1 diabetes. Curr Med Res Opin. Whipple AO. Thesurgical therapy of hyperinsu-linism. J Int Chir. American Diabetes Association. Glycemic targets: standards of medical care in diabetes— Lamounier RN, Geloneze B, Leite SO, Montenegro R, Zajdenverg L, Fernandes M, et al. Hypoglycemia incidence and awareness among insulin-treated patients with diabetes: the HAT study in Brazil. Diabetol Metab Syndr. Amiel SA, Choudhary P, Jacob P, Smith EL, De Zoysa N, Gonder-Frederick L, et al. Hypoglycaemia awareness restoration programme for people with type 1 diabetes and problematic hypoglycaemia persisting despite optimised self-care HARPdoc : protocol for a group randomised controlled trial of a novel intervention addressing cognitions. BMJ Open. Hopkins D, Lawrence IA, Mansell P, Thompson G, Amiel S, Campbell M, et al. Improved biomedical and psychological outcomes 1 year after structured education in flexible insulin therapy for people with type 1 diabetes: the UK DAFNE experience. Binder C, Bendtson I. Endocrine emergencies. Pedersen-Bjergaard U, Pramming S, Heller SR, Wallace TM, Rasmussen ÅK, Jørgensen HV, et al. Severe hypoglycaemia in adult patients with type 1 diabetes: influence of risk markers and selection. Diabetes Metab Res Rev. Zammitt NN, Geddes J, Warren RE, Marioni R, Ashby JP, Frier BM. Serum angiotensin-converting enzyme and frequency of severe hypoglycaemia in Type 1 diabetes: does a relationship exist? Diabet Med. McCulloch D. Physiologic response to hypoglycemia in normal subjects and patients with diabetes mellitus. Up to Date Medical , Becker K. Endocrine drugs and values. Principles and practice of endocrinology and metabolism. Philadelphia: JB Lippincott; Hypoglycemia in the diabetes control and complications trial. Diamond MP, Reece EA, Caprio S, Jones TW, Amiel S, DeGennaro N, et al. Impairment of counterregulatory hormone responses to hypoglycemia in pregnant women with insulin-dependent diabetes mellitus. Am J Obstet Gynecol. Nakhjavani M, Esteghamati A, Emami F, Hoseinzadeh M. Iran J Endocrinol Metabol. Holleman F, Schmitt H, Rottiers R, Rees A, Symanowski S, Anderson JH, et al. Reduced frequency of severe hypoglycemia and coma in well-controlled IDDM patients treated with insulin lispro. Brunelle RL, Llewelyn J, Anderson JH Jr, Gale EA, Koivisto VA. Meta-analysis of the effect of insulin lispro on severe hypoglycemia in patients with type 1 diabetes. Anderson JH Jr, Brunelle RL, Koivisto VA, Pfützner A, Trautmann ME, Vignati L, et al. Reduction of postprandial hyperglycemia and frequency of hypoglycemia in IDDM patients on insulin-analog treatment. Monami M, Marchionni N, Mannucci E. Long-acting insulin analogues versus NPH human insulin in type 2 diabetes: a meta-analysis. Diabetes Res Clin Pract. Smith CB, Choudhary P, Pernet A, Hopkins D, Amiel SA. Hypoglycemia unawareness is associated with reduced adherence to therapeutic decisions in patients with type 1 diabetes: evidence from a clinical audit. Cranston I, Lomas J, Amiel SA, Maran A, Macdonald I. Restoration of hypoglycaemia awareness in patients with long-duration insulin-dependent diabetes. Battelino T, et al. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Wolpert HA. Use of continuous glucose monitoring in the detection and prevention of hypoglycemia. J Diabetes Sci Technol. Fritsche A, Stumvoll M, Häring HU, Gerich JE. Reversal of hypoglycemia unawareness in a long-term type 1 diabetic patient by improvement of β-adrenergic sensitivity after prevention of hypoglycemia. J Clin Endocrinol Metab. Hypoglycemia-associated autonomic failure in diabetes. Am J Physiol Endocrinol Metabol. Fanelli CG, et al. Meticulous prevention of hypoglycemia normalizes the glycemic thresholds and magnitude of most of neuroendocrine responses to, symptoms of, and cognitive function during hypoglycemia in intensively treated patients with short-term IDDM. Dagogo-Jack S, Rattarasarn C, Cryer PE. Reversal of hypoglycemia unawareness, but not defective glucose counterregulation, in IDDM. Download references. In appreciation, we express our gratitude to Dr. Rafiee for sharing the patient history and encouraging us to share this case as a valuable subject for other physicians. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, First Floor, No 10, Jalal-Al-Ahmad Street, North Kargar Avenue, Tehran, , Iran. Radiology Department, Iran University of Medical Sciences, Tehran, Iran. Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Tehran University of Medical Sciences, Tehran, Iran. You can also search for this author in PubMed Google Scholar. YSH: Study conception and design, data collection, and draft manuscript preparation. ME, SST: Draft of manuscript. All authors reviewed the results and read and approved the final manuscript. Correspondence to Yasaman Sharifi. Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of the Journal of Medical Case Reports. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is licensed under a Creative Commons Attribution 4. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and permissions. Sharifi, Y. Hypoglycemic unawareness: challenges, triggers, and recommendations in patients with hypoglycemic unawareness: a case report. J Med Case Reports 16 , Download citation. Received : 14 January Accepted : 14 June Published : 21 July Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background Hypoglycemia is a fairly common complication in diabetic patients, particularly in those on insulin therapy. Case presentation A year-old Iranian woman with HU presented with a severe hypoglycemic episode. Conclusions Hypoglycemia is a common complication in diabetic patients receiving oral or insulin therapy. Background Hypoglycemia is a relatively common complication in diabetic patients, particularly those on insulin therapy [ 1 ]. Case presentation A year-old Iranian woman weight: 57 kg; body mass index: Table 1 Results of the blood examination on first admission Full size table. Discussion Hypoglycemia is a common side effect of various diabetes medications, such as insulin and sulfonylureas [ 8 , 11 ]. 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. Daneman D, Frank M, Perlman K, et al. Severe hypoglycemia in children with insulin-dependent diabetes mellitus: Frequency and predisposing factors. J Pediatr ;—5. Berlin I, Sachon CI, Grimaldi A. Identification of factors associated with impaired hypoglycaemia awareness in patients with type 1 and type 2 diabetes mellitus. Diabetes Metab ;— Schultes B, Jauch-Chara K, Gais S, et al. Defective awakening response to nocturnal hypoglycemia in patients with type 1 diabetes mellitus. PLoS Med ;4:e Porter PA, Byrne G, Stick S, et al. Nocturnal hypoglycaemia and sleep disturbances in young teenagers with insulin dependent diabetes mellitus. Arch Dis Child ;—3. Gale EA, Tattersall RB. Unrecognised nocturnal hypoglycaemia in insulintreated diabetics. Lancet ;— Beregszàszi M, Tubiana-Rufi N, Benali K, et al. Nocturnal hypoglycemia in children and adolescents with insulin-dependent diabetes mellitus: Prevalence and risk factors. Vervoort G, Goldschmidt HM, van Doorn LG. Diabet Med ;—9. Ovalle F, Fanelli CG, Paramore DS, et al. Brief twice-weekly episodes of hypoglycemia reduce detection of clinical hypoglycemia in type 1 diabetes mellitus. Diabetes ;—9. Fanelli CG, Epifano L, Rambotti AM, et al. Meticulous prevention of hypoglycemia normalizes the glycemic thresholds and magnitude of most of neuroendocrine responses to, symptoms of, and cognitive function during hypoglycemia in intensively treated patients with short-term IDDM. Dagogo-Jack S, Rattarasarn C, Cryer PE. Reversal of hypoglycemia unawareness, but not defective glucose counterregulation, in IDDM. Fanelli C, Pampanelli S, Epifano L, et al. Long-term recovery from unawareness, deficient counterregulation and lack of cognitive dysfunction during hypoglycaemia, following institution of rational, intensive insulin therapy in IDDM. Dagogo-Jack S, Fanelli CG, Cryer PE. Durable reversal of hypoglycemia unawareness in type 1 diabetes. Diabetes Care ;—7. Davis M, Mellman M, Friedman S, et al. Recovery of epinephrine response but not hypoglycemic symptomthreshold after intensive therapy in type 1 diabetes. Am J Med ;— Liu D, McManus RM, Ryan EA. Improved counter-regulatory hormonal and symptomatic responses to hypoglycemia in patients with insulin-dependent diabetes mellitus after 3 months of less strict glycemic control. Clin Invest Med ;— Lingenfelser T, Buettner U, Martin J, et al. Improvement of impaired counterregulatory hormone response and symptom perception by short-term avoidance of hypoglycemia in IDDM. Kinsley BT,Weinger K, Bajaj M, et al. Blood glucose awareness training and epinephrine responses to hypoglycemia during intensive treatment in type 1 diabetes. Diabetes Care ;—8. Schachinger H, Hegar K, Hermanns N, et al. Randomized controlled clinical trial of Blood Glucose Awareness Training BGAT III in Switzerland and Germany. J Behav Med ;— Yeoh E, Choudhary P, Nwokolo M, et al. Interventions that restore awareness of hypoglycemia in adults with type 1 diabetes: A systematic review and metaanalysis. van Dellen D, Worthington J, Mitu-Pretorian OM, et al. Mortality in diabetes: Pancreas transplantation is associated with significant survival benefit. Nephrol Dial Transplant ;— Ly TT, Nicholas JA, Retterath A, et al. Effect of sensor-augmented insulin pump therapy and automated insulin suspension vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes: A randomized clinical trial. JAMA ;—7. Little SA, Leelarathna L,Walkinshaw E, et al. Recovery of hypoglycemia awareness in long-standing type 1 diabetes: A multicenter 2 x 2 factorial randomized controlled trial comparing insulin pump with multiple daily injections and continuous with conventional glucose self-monitoring HypoCOMPaSS. Bergenstal RM, Klonoff DC, Garg SK, et al. Threshold-based insulin-pump interruption for reduction of hypoglycemia. N Engl J Med ;— van Beers CAJ, DeVries JH, Kleijer SJ, et al. Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia IN CONTROL : A randomised, open-label, crossover trial. Lancet Diabetes Endocrinol ;— Hering BJ, Clarke WR, Bridges ND, et al. Phase 3 trial of transplantation of human islets in type 1 diabetes complicated by severe hypoglycemia. Rickels MR. Recovery of endocrine function after islet and pancreas transplantation. Curr Diab Rep ;— Moassesfar S, Masharani U, Frassetto LA, et al. A comparative analysis of the safety, efficacy, and cost of islet versus pancreas transplantation in nonuremic patients with type 1 diabetes. Am J Transplant ;— Kendall DM, Rooney DP, Smets YF, et al. Pancreas transplantation restores epinephrine response and symptom recognition during hypoglycemia in patients with long-standing type I diabetes and autonomic neuropathy. Paty BW, Lanz K, Kendall DM, et al. Restored hypoglycemic counterregulation is stable in successful pancreas transplant recipients for up to 19 years after transplantation. Transplantation ;—7. Barrou Z, Seaquist ER, Robertson RP. Pancreas transplantation in diabetic humans normalizes hepatic glucose production during hypoglycemia. Diabetes ;—6. Davis SN, Mann S, Briscoe VJ, et al. Effects of intensive therapy and antecedent hypoglycemia on counterregulatory responses to hypoglycemia in type 2 diabetes. Diabetes Research in Children Network DirecNet Study Group, Tsalikian E, Tamborlane W, et al. Blunted counterregulatory hormone responses to hypoglycemia in young children and adolescents with well-controlled type 1 diabetes. Diabetes Care ;—9. Bruce DG, DavisWA, Casey GP, et al. Severe hypoglycaemia and cognitive impairment in older patients with diabetes: The Fremantle Diabetes Study. Zhang Z, Lovato J, Battapady H, et al. 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Effects of acute insulin-induced hypoglycemia on indices of inflammation: Putative mechanism for aggravating vascular disease in diabetes. Gogitidze Joy N, Hedrington MS, Briscoe VJ, et al. Effects of acute hypoglycemia on inflammatory and pro-atherothrombotic biomarkers in individuals with type 1 diabetes and healthy individuals. RKoivikko ML, Karsikas M, Salmela PI, et al. Effects of controlled hypoglycaemia on cardiac repolarisation in patients with type 1 diabetes. RKubiak T, Wittig A, Koll C, et al. Continuous glucose monitoring reveals associations of glucose levels with QT interval length. Diabetes Technol Ther ;—6. RWright RJ, Frier BM. Vascular disease and diabetes: Is hypoglycaemia an aggravating factor? Diabetes Metab Res Rev ;— RFrier BM, Schernthaner G, Heller SR. Hypoglycemia and cardiovascular risks. Diabetes Care ;34 Suppl. RStahn A, Pistrosch F, Ganz X, et al. Relationship between hypoglycemic episodes and ventricular arrhythmias in patients with type 2 diabetes and cardiovascular diseases: Silent hypoglycemias and silent arrhythmias. RSkyler JS, Bergenstal R, Bonow RO, et al. Intensive glycemic control and the prevention of cardiovascular events: Implications of the ACCORD, ADVANCE, and VA diabetes trials: A position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. RSlama G, Traynard PY, Desplanque N, et al. The search for an optimized treatment of hypoglycemia. carbohydrates in tablets, solutin, or gel for the correction of insulin reactions. Arch Intern Med ;— RWiethop BV, Cryer PE. Alanine and terbutaline in treatment of hypoglycemia in IDDM. RBrodows RG, Williams C, Amatruda JM. Treatment of insulin reactions in diabetics. JAMA ;— RSkyler JS Ed. Alexandria, VA, American Diabetes Association, Canadian Diabetes Association. |
Ich entschuldige mich, aber es kommt mir nicht heran. Es gibt andere Varianten?
Die Idee ausgezeichnet, ist mit Ihnen einverstanden.
Sie lassen den Fehler zu. Schreiben Sie mir in PM, wir werden umgehen.
Ich tue Abbitte, dass sich eingemischt hat... Aber mir ist dieses Thema sehr nah. Ist fertig, zu helfen.
Es kommt mir nicht heran.