Hypoglycaemia
In health hypoglycaemia is rare and occurs only in circumstances like extreme sports. Hypoglycaemia in type 1 Diabetes (T1D) and advanced type 2 Diabetes (T2D) are the result of interplay between absolute or relative insulin access and defective glucose c
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Hypoglycaemia Muhammad Muneer
hypoglycaemia. Exogenous insulin in T1D and insulin treated advanced T2D have no control by pancreatic regulation. Moreover, failure of increase of glucagon and attenuated secretion in epinephrine causes the defective glucose counterregulation. In this comprehensive review, I will try to touch all related topics for better understanding of hypoglycaemia.
Abstract
In health hypoglycaemia is rare and occurs only in circumstances like extreme sports. Hypoglycaemia in type 1 Diabetes (T1D) and advanced type 2 Diabetes (T2D) are the result of interplay between absolute or relative insulin access and defective glucose counterregulation. The basic mechanism is, failure of decreasing insulin and failure of the compensatory increasing counterregulatory hormones at the background of falling blood glucose. Any person with Diabetes on anti-diabetic medication who behaves oddly in any way whatsoever is hypoglycaemic until proven otherwise. Hypoglycaemia can be a terrifying experience for a patient with Diabetes. By definition, hypoglycaemic symptoms are subjective and vary from person to person and even episode to episode in same person. Fear of iatrogenic hypoglycaemia is a major barrier in achieving optimum glycaemic control and quality of life which limits the reduction of diabetic complications. Diabetes patients with comorbidities especially with chronic renal failure, hepatic dysfunction, major limb amputation, terminal illness, cognitive dysfunction etc. are more vulnerable to hypoglycaemia. In most cases, prompt glucose intake reverts M. Muneer (*) Cardiff University, Cardiff, UK Green Apple Medical Center, Muscat, Sultanate of Oman e-mail: [email protected]
Keywords
T1D (Type 1 Diabetes) · T2D (Type 2 Diabetes) · IAH (Impaired Awareness of Hypoglycaemia) · HAAF (Hypoglycaemia Associated Autonomic Failure) · Autonomic, Neuroglycopenic · IHSG (International Hypoglycemia Study Group) · ADA (American Diabetes Association) · ES (The Endocrine Society) · UKHSG (UK Hypoglycaemia Study Group)
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Introduction
Hypoglycaemia is the commonest acute complication in T1D and may also occur in T2D who are on insulin, sulphonylurea or glinide therapy (Balijepalli et al. 2017). It is a major physiological and psychological barrier to have targeted glycaemic control that might lead to the risk of diabetes complications and emotional morbidity to the patients and a serious concern to its caregivers as well. Monitoring hypoglycaemia
M. Muneer
should be one of the key component of diabetes care in health and during sick days. Educating patient regarding its symptoms, causes, risk factors, prevention and treatment should be an integral part of each visit. Although intensive glycaemic control has been shown to reduce complications in diabetes, it also significantly increases the risk of hypoglycaemia (UKPDS Study Group 1998; The Diabetes Control and Complications Trial Research G
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