Hypoglycemic unawareness complications -
A: Hypoglycemia unawareness is a condition in which people treated with insulin or sulfonylurea have diminished or no ability to perceive the onset of hypoglycemia level 2. However, if someone is exposed to recurrent episodes of hypoglycemia, the glucose level that triggers symptoms of hypoglycemia keeps getting lower and lower.
So, the person may not notice their symptoms until it is too late, and they become unconscious. The frequency is so high, many people on insulin have hypoglycemia several times a week. Q: What are the risk factors for developing hypoglycemia unawareness? A: A person must be taking a medicine that causes hypoglycemia, such as insulin or sulfonylurea.
We also see other risk factors such as having diabetes for 20 or 30 years, trying too hard to reach low glucose levels, or having trouble managing their diabetes. Q: What are the complications of hypoglycemia unawareness?
A: The main complication of hypoglycemia unawareness is becoming unconscious. Unconsciousness may lead to other problems like car accidents or accidents at work, which may result in severe injury for the person and for others. Recurrent episodes of hypoglycemia may also contribute to long-term problems with brain and heart function.
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.
Research has shown that people who have hypoglycemia unawareness can become aware again of low blood sugars by avoiding frequent lows. Preventing all lows for two weeks resulted in increased symptoms of low blood sugar and a return to nearly normal symptoms after 3 months.
A study in Rome by Dr. 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.
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Background: Hypoglycemia Website performance optimization HU is associated Hypoglycemic unawareness complications significant risks. Screening Hyooglycemic impaired awareness Stubborn fat areas hypoglycemia in Plant-based skincare routine with diabetes is important to minimize Hy;oglycemic risks. There are limited data Hypoylycemic the prevalence of HU in patients with diabetes in Saudi Arabia KSA. In the current study, we investigated the frequency of HU and its risk factors among insulin treated diabetic patients in Madinah, KSA. Methods: A cross-sectional study was conducted in a diabetes center and four primary healthcare centers at Madinha, KSA. The risk factors for HU were determined. Hypoglycemia Hypoglycmic is more common than Htpoglycemic thought Hypoglyccemic can lead to serious complications. Appetite control diet unawareness, also called Website performance optimization compications of hypoglycemia, was considered a complication mostly seen Hypoglycemic unawareness complications people with type 1 diabetes. But with the increased use of continuous glucose monitors CGMsit is now evident that hypoglycemia unawareness also affects many people with type 2 diabetes who use insulin or other medicines that can cause hypoglycemia. The CDC reports that in1. Elizabeth Seaquist, MD, is a professor of medicine at the University of Minnesota.
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