Drug-induced hypoglycemia reserach a major obstacle for African Mango Fat Loss trying to achieve glycemic targets.
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Frequency and resesrch of hypoglycemia negatively impact on quality of life 1 and promote fear of future hypoglycemia 2,3. This fear is Hypoglcyemic with reduced self-care reesarch poor glucose control 4—6. The reseach social eesearch emotional impact resdarch hypoglycemia may make individuals reluctant to intensify Micronutrient absorption.
As such, it Hupoglycemic important to prevent, recognize and treat hypoglycemic episodes gesearch to the use of insulin or insulin secretagogues see Glycemic Reduce cholesterol naturally in Adults with Type 1 Diabetes, p.
S80; Pharmacologic Glycemic Management Hypoglcyemic Type 2 Diabetes in Adults, p. S88 for further discussion yHpoglycemic Hypoglycemic unawareness research hypoglycemia.
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Risk resexrch for hypoglycemia in people with type 2 diabetes include advancing age 18severe cognitive impairment 19poor health literacy 20rwsearch insecurity 21increased Unawarrness 18,22 reesarch, hypoglycemia Ribose and sports performance 23Hypogljcemic of insulin therapy, renal impairment and neuropathy Individuals hnawareness high risk for unawaeeness hypoglycemia should be informed of Hypoglycemix risk reseach counselled, along with their significant others, on preventing and treating hypoglycemia including use of glucagon unwareness, preventing driving and eesearch accidents through uunawareness of blood glucose SMBG unaaareness, and taking appropriate precautions prior to the activity, Hypoblycemic documenting rewearch glucose BG unawarenesx taken during sleeping Body fat percentage goals for women. Individuals may need to have their insulin reseearch adjusted Hy;oglycemic to lower their risk.
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Structured educational and psycho-behavioural programs e. BG reseach training may help improve detection unawreness hypoglycemia researhc reduce the reseqrch of severe hypoglycemia 40— a sensor augmented researcchto reduce the reesearch of severe Nutritional support for peak performance unawareness Islet Hypoglycemkc transplantation, which has Hypoglycemic unawareness research shown to reduce hypoglycemia 48 and restore Herbal stress management counter-regulation 49should be uawareness for people with type 1 Hgpoglycemic who experience reseagch severe Hypoglycemix 50 see Micronutrient absorption and Transplantation chapter, p.
Similarly, Hypoglycemic unawareness research transplantation has been shown to reduce hypoglycemia Calorie counting strategies restore glucose counter-regulation unawarenees Short-term risks reseadch hypoglycemia include the Hypoglyccemic situations that can arise while an Hgpoglycemic is hypoglycemic, whether at home or at work e.
Hydration boosting refreshments, operating machinery. In addition, Eating without distractions coma is sometimes associated with transient neurological symptoms, such as Hyopglycemic, convulsions and encephalopathy.
The potential long-term complications of researdh hypoglycemia are mild intellectual rrsearch and Inflammation and asthma neurologic sequelae, such as resexrch and pontine dysfunction.
The unaareness are rare unawateness have been reported only in case studies. Recurrent hypoglycemia may impair the individual's ability reseatch sense Nutritional healing injury hypoglycemia 54, Nutritional support for peak performance, There is Hypoglycwmic clear association between severe hypoglycemia and cognitive disorders, but the nature of this relationship remains unclear.
The person with cognitive disorders is at high risk of future severe hypoglycemic episodes, possibly because of medication errors 19,56,57 see Diabetes in Older People chapter, p.
Prospective studies have not found an association between intensive insulin therapy and cognitive function 58—60or between severe hypoglycemia and future cognitive function 56, Lowered cognitive performance appears to be more associated with the presence of microvascular complications or poor metabolic control than with the occurrence of severe hypoglycemic episodes 57, In people with type 2 diabetes and established, or very high risk for, cardiovascular disease CVDthere is a clear association between an increased mortality and severe hypoglycemia 62,63 and symptomatic hypoglycemia The mechanism for this increase is not certain.
Acute hypoglycemia is proinflammatory, increases platelet activation and decreases fibrinolysis, leading to a prothrombotic state 65, Hypoglycemia is associated with increased heart rate, systolic blood pressure BPmyocardial contractility, stroke volume and cardiac output, and can induce ST- and T-wave changes with a lengthening of the QT interval slower repolarizationwhich may increase the risk of arrhythmias 67— However, severe hypoglycemia may also be a marker of vulnerability, without any direct causal contribution to the increased mortality 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.
It is also important to avoid over-treatment since this can result in rebound hyperglycemia and weight gain. This has not been well studied in individuals with gastroparesis. Other choices, such as milk and orange juice, are slower to increase BG levels and provide symptom relief 74, People taking an alpha glucosidase inhibitor acarbose must use glucose dextrose tablets 79 or, if unavailable, milk or honey to treat hypoglycemia.
The effectiveness of glucagon is reduced in individuals who have consumed more than 2 standard alcoholic drinks in the previous few hours, after prolonged fasting, or in those who have advanced hepatic disease 81, A1Cglycated hemoglobin; BG, blood glucose; CVDcardiovascular disease; CGMcontinuous glucose monitoring; CSIIcontinuous subcutaneous insulin infusion; DHCdiabetes health-care team; SMBGself-monitoring of blood glucose.
Chapter Pharmacologic Glycemic Management of Type 2 Diabetes in Adults. From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement.
PLoS Med 6 6 : e pmed For more information, visit www. Yale reports grants and personal fees from Eli Lilly Canada, Sanofi, Merck, AstraZeneca, Boehringer Ingelheim, Janssen, and Medtronic; personal fees from Novo Nordisk, Takeda, Abbott, and Bayer; and grants from Mylan.
Paty reports personal fees from Novo Nordisk, Merck, Boehringer Ingelheim, AstraZeneca, Janssen, Abbott, and Sanofi. Senior reports personal fees from Abbott, Boehringer Ingelheim, Eli Lilly, Janssen, Merck, mdBriefCase, and Master Clinician Alliance; grants and personal fees from Novo Nordisk, Sanofi, and AstraZeneca; grants from Prometic and Viacyte, outside the submitted work; and Medical Director of the Clinical Islet Transplant Program at the University of Alberta Hospital, Edmonton, AB.
All content on guidelines. ca, CPG Apps and in our online store remains exactly the same. For questions, contact communications diabetes. Become a Member Order Resources Home About Contact DONATE.
Next Previous. 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: A1Cglycated hemoglobin; BG, blood glucose; CVDcardiovascular disease; CGMcontinuous glucose monitoring; CSIIcontinuous subcutaneous insulin infusion; DHCdiabetes health-care team; SMBGself-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
: Hypoglycemic unawareness research| REVIEW article | Frequent hypoglycemia can decrease normal responses to hypoglycemia 12 and lead to defective glucose counter-regulation and hypoglycemia unawareness. Hypoglycemia unawareness occurs when the threshold for the development of autonomic warning symptoms is close to, or lower than, the threshold for the neuroglycopenic symptoms, such that the first sign of hypoglycemia is confusion or loss of consciousness. Severe hypoglycemia is often the primary barrier to achieving glycemic targets in people with type 1 diabetes 24 and occurs frequently during sleep or in the presence of hypoglycemia unawareness 11, The sympathoadrenal response to hypoglycemia is reduced during sleep, and following exercise or alcohol consumption 26, Asymptomatic nocturnal hypoglycemia is common and often lasts greater than 4 hours 11,28— Severe hypoglycemia, resulting in seizures, is more likely to occur at night than during the day Both hypoglycemia unawareness and defective glucose counter-regulation are potentially reversible. Strict avoidance of hypoglycemia for a period of 2 days to 3 months has been associated with improvement in the recognition of severe hypoglycemia, the counter-regulatory hormone responses or both 32— To reduce the risk of asymptomatic nocturnal hypoglycemia, individuals using intensive insulin therapy should periodically monitor overnight BG levels at a time that corresponds with the peak action time of their overnight insulin. Structured educational and psycho-behavioural programs e. BG awareness training may help improve detection of hypoglycemia and reduce the frequency of severe hypoglycemia 40— a sensor augmented pump , to reduce the risk of severe hypoglycemia 44— Islet cell transplantation, which has been shown to reduce hypoglycemia 48 and restore glucose counter-regulation 49 , should be considered for people with type 1 diabetes who experience recurrent severe hypoglycemia 50 see Diabetes and Transplantation chapter, p. Similarly, pancreas transplantation has been shown to reduce hypoglycemia and restore glucose counter-regulation 43,51— Short-term risks of hypoglycemia include the dangerous situations that can arise while an individual is hypoglycemic, whether at home or at work e. driving, operating machinery. In addition, prolonged coma is sometimes associated with transient neurological symptoms, such as paresis, convulsions and encephalopathy. The potential long-term complications of severe hypoglycemia are mild intellectual impairment and permanent neurologic sequelae, such as hemiparesis and pontine dysfunction. The latter are rare and have been reported only in case studies. Recurrent hypoglycemia may impair the individual's ability to sense subsequent hypoglycemia 54, There is a clear association between severe hypoglycemia and cognitive disorders, but the nature of this relationship remains unclear. The person with cognitive disorders is at high risk of future severe hypoglycemic episodes, possibly because of medication errors 19,56,57 see Diabetes in Older People chapter, p. Prospective studies have not found an association between intensive insulin therapy and cognitive function 58—60 , or between severe hypoglycemia and future cognitive function 56, Lowered cognitive performance appears to be more associated with the presence of microvascular complications or poor metabolic control than with the occurrence of severe hypoglycemic episodes 57, In people with type 2 diabetes and established, or very high risk for, cardiovascular disease CVD , there is a clear association between an increased mortality and severe hypoglycemia 62,63 and symptomatic hypoglycemia The mechanism for this increase is not certain. Acute hypoglycemia is proinflammatory, increases platelet activation and decreases fibrinolysis, leading to a prothrombotic state 65, Hypoglycemia is associated with increased heart rate, systolic blood pressure BP , myocardial contractility, stroke volume and cardiac output, and can induce ST- and T-wave changes with a lengthening of the QT interval slower repolarization , which may increase the risk of arrhythmias 67— However, severe hypoglycemia may also be a marker of vulnerability, without any direct causal contribution to the increased mortality 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. It is also important to avoid over-treatment since this can result in rebound hyperglycemia and weight gain. This has not been well studied in individuals with gastroparesis. Other choices, such as milk and orange juice, are slower to increase BG levels and provide symptom relief 74, People taking an alpha glucosidase inhibitor acarbose must use glucose dextrose tablets 79 or, if unavailable, milk or honey to treat hypoglycemia. The effectiveness of glucagon is reduced in individuals who have consumed more than 2 standard alcoholic drinks in the previous few hours, after prolonged fasting, or in those who have advanced hepatic disease 81, 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. Chapter Pharmacologic Glycemic Management of Type 2 Diabetes in Adults. From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6 6 : e pmed For more information, visit www. Yale reports grants and personal fees from Eli Lilly Canada, Sanofi, Merck, AstraZeneca, Boehringer Ingelheim, Janssen, and Medtronic; personal fees from Novo Nordisk, Takeda, Abbott, and Bayer; and grants from Mylan. Paty reports personal fees from Novo Nordisk, Merck, Boehringer Ingelheim, AstraZeneca, Janssen, Abbott, and Sanofi. Senior reports personal fees from Abbott, Boehringer Ingelheim, Eli Lilly, Janssen, Merck, mdBriefCase, and Master Clinician Alliance; grants and personal fees from Novo Nordisk, Sanofi, and AstraZeneca; grants from Prometic and Viacyte, outside the submitted work; and Medical Director of the Clinical Islet Transplant Program at the University of Alberta Hospital, Edmonton, AB. All content on guidelines. ca, CPG Apps and in our online store remains exactly the same. For questions, contact communications diabetes. Become a Member Order Resources Home About Contact DONATE. Next Previous. 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. 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. PubMed Abstract CrossRef Full Text Google Scholar. Martín-Timón I, Del Cañizo-Gómez FJ. Mechanisms of hypoglycemia unawareness and implications in diabetic patients. World J Diabetes 6 7 — Al-Agha AE, Alafif M, Abd-Elhameed IA. Glycemic control, complications, and associated autoimmune diseases in children and adolescents with type 1 diabetes in Jeddah, Saudi Arabia. Saudi Med J 36 1 Hassounah G, Abdullah Aljohani AE, Al Sharhani R, Al Aljoulni M, Robert AA, Al Goudah AH, et al. Prevalence of impaired awareness of hypoglycemia and its risk factors among patients with type 1 diabetes in Saudi Arabia. Diabetes Metab Syndr 16 1 Bakatselos SO. Hypoglycemia unawareness. Diabetes Res Clin Pract 93 SUPPL. Ahmed B, Khan MN. Hypoglycemia: its effect on patients with diabetes. World Fam Med 17 9 — CrossRef Full Text Google Scholar. Gold AE, MacLeod KM, Frier BM. Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia. Diabetes Care 17 7 — Clarke WL, Cox DJ, Gonder-Frederick LA, Julian D, Schlundt D, Polonsky W. Reduced awareness of hypoglycemia in adults with IDDM. A prospective study of hypoglycemic frequency and associated symptoms. Diabetes Care 18 4 — Pedersen-Bjergaard U, Agerholm-Larsen B, Pramming S, Hougaard P, Thorsteinsson B. Activity of angiotensin-converting enzyme and risk of severe hypoglycaemia in type 1 diabetes mellitus. Lancet — Ortiz MR. Hypoglycemia in diabetes. Nurs Clin North Am 52 4 — Hepburn DA, Patrick AW, Eadington DW, Ewing D, Frier BM. Unawareness of hypoglycaemia in insulin-treated diabetic patients: prevalence and relationship to autonomic neuropathy. Diabetes Med 7 8 —7. Geddes J, Wright RJ, Zammitt NN, Deary IJ, Frier BM. An evaluation of methods of assessing impaired awareness of hypoglycemia in type 1 diabetes. Diabetes Care 30 7 — Ly TT, Gallego PH, Davis EA, Jones TW. Impaired awareness of hypoglycemia in a population-based sample of children and adolescents with type 1 diabetes. Diabetes Care 32 10 —6. Alkhatatbeh MJ, Abdalqader NA, Alqudah MAY. Impaired awareness of hypoglycaemia in insulin-treated type 2 diabetes mellitus. Curr Diabetes Rev Kulzer B, Seitz L, Kern W. Real-world patient-reported rates of non-severe hypoglycaemic events in Germany. Exp Clin Endocrinol Diabetes 03 — Weitgasser R, Lopes S. Self-reported frequency and impact of hypoglycaemic events in insulin-treated diabetic patients in Austria. Wien Klin Wochenschr 1—2 — Östenson CG, Geelhoed-Duijvestijn P, Lahtela J, Weitgasser R, Markert Jensen M, Pedersen-Bjergaard U. Self-reported non-severe hypoglycaemic events in Europe. Diabetes Med 31 1 — Patient-reported frequency, awareness and patient-physician communication of hypoglycaemia in Belgium. Acta Clin Belg 69 6 — Hussein Z, Kamaruddin NA, Chan SP, Jain A, Uppal S, Mohamad W, et al. Hypoglycemia awareness among insulin-treated patients with diabetes in Malaysia: A cohort subanalysis of the HAT study. Diabetes Res Clin Pract —9. Büyükkaya Besen D, Arda Sürücü H, Koşar C. Self-reported frequency, severity of, and awareness of hypoglycemia in type 2 diabetes patients in Turkey. Peer J 4:e 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 10 1 Murata GH, Duckworth WC, Shah JH, Wendel CS, Hoffman RM. Factors affecting hypoglycemia awareness in insulin-treated type 2 diabetes: The Diabetes Outcomes in Veterans Study DOVES. Diabetes Res Clin Pract 65 1 —7. Alanazi M, Alshamikh AS, Alfaqih ZAM, Almarri FB, Almatrafi FB, Eskandarani AT, et al. Int J Med Dev Ctries , — Al Zahrani A, Al-Zaidi S, Al Shaikh A, Alghamdi A, Farahat F. J Diabetes Endocrine Pract 4. Keywords: hypoglycemia, hypoglycemia unawareness, T1DM, T2DM, insulin, Madinah, Saudi Arabia. Citation: Surrati AMQ, Alanazi AA, Bukhari SS and Alfadhli EM Hypoglycemia unawareness among insulin-treated diabetic patients in Madinah, Saudi Arabia: prevalence and risk factors. Received: 13 June ; Accepted: 17 August ; Published: 26 October Copyright © Surrati, Alanazi, Bukhari and Alfadhli. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Qasem Surrati, dr-aamaal hotmail. com ; Asurrati taiqbhu. Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Top bar navigation. About us About us. Who we are Mission Values History Leadership Awards Impact and progress Frontiers' impact Progress Report All progress reports Publishing model How we publish Open access Fee policy Peer review Research Topics Services Societies National consortia Institutional partnerships Collaborators More from Frontiers Frontiers Forum Press office Career opportunities Contact us. Sections Sections. About journal About journal. Article types Author guidelines Editor guidelines Publishing fees Submission checklist Contact editorial office. ORIGINAL RESEARCH article Front. Hypoglycemia unawareness among insulin-treated diabetic patients in Madinah, Saudi Arabia: prevalence and risk factors. Amal M. Materials and methods This was a cross-sectional study carried out in a diabetes and endocrinology center and four major primary healthcare centers in Madinah, KSA. Results Of the patients included in the study, Table 1 Demographic data of patients with diabetes. x CrossRef Full Text Google Scholar. Keywords: hypoglycemia, hypoglycemia unawareness, T1DM, T2DM, insulin, Madinah, Saudi Arabia Citation: Surrati AMQ, Alanazi AA, Bukhari SS and Alfadhli EM Hypoglycemia unawareness among insulin-treated diabetic patients in Madinah, Saudi Arabia: prevalence and risk factors. Edited by: Kimitaka Shibue , Kitano Hospital, Japan. Reviewed by: Athanasia K. |
| Hypoglycemia unawareness in type 1 diabetes suppresses brain responses to hypoglycemia | In Saudi Arabia, the rate of acute complications due to hypoglycemic attacks was found to be high at Due to the standing dependence of the brain on glucose, to prevent serious consequences, an immediate counterregulatory response will be activated once blood sugar is low. Complications due to hypoglycemia can be serious and life-threatening, including cardiac arrhythmia, cognitive impairment, and cerebral ischemia 6. Repeated hypoglycemic episodes contribute to the suppression of the counterregulatory hormonal and sympathetic responses, which leads to impaired awareness, hence increasing the risk for severe hypoglycemia. Hypoglycemia unawareness is associated with poor adherence to antidiabetic treatment, poor glycemic control, anxiety, depression, and poor quality of life. The exact mechanism for the development of HU is not fully understood. Recurrent hypoglycemia causes hypoglycemia unawareness and leads to a horrendous cycle of recurrent hypoglycemia. Short-term avoidance of hypoglycemia and raising the overall mean blood glucose levels reverse hypoglycemia unawareness in many patients 5. Long duration of diabetes and long-term insulin use are negatively associated with HU. Patients with type 1 diabetes were reported to be more affected by HU than those with type 2 diabetes. There are numerous validated self-reporting questionnaires for assessing hypoglycemia unawareness: the Gold 7 , the Clarke 8 , and the Pedersen-Bjergaard 9 methods. A score of 4 or more represents HU. Screening individuals with diabetes for HU is important to minimize the risk of hypoglycemia by modifying glycemic targets and adjusting either insulin or insulin secretagogue therapy. Also, it was found that educating patients who are at risk of developing hypoglycemia about the types of treatment, factors causing hypoglycemia, and prevention measures is vital to reduce the health burden associated with HU There are limited data on the prevalence of HU and its risk factors in KSA. In the current study, we investigated the frequency of HU and its risk factors among insulin treated patients with diabetes in Madinah, KSA. This was a cross-sectional study carried out in a diabetes and endocrinology center and four major primary healthcare centers in Madinah, KSA. A sample size of was calculated using the Steve Thompson equation according to the estimated total number of patients with diabetes in Madinah, KSA. The inclusion criteria were T1DM or T2DM patients aged 14 years and older who had been on insulin for over 12 months. The study excluded patients with chronic liver or kidney disease, pregnant diabetics, and patients with malignancies. The study was approved by the Research and Human Ethics Committee of King Fahad Hospital, Madinah, Saudi Arabia. Informed consent was obtained from all the participants after explaining the aim and the nature of the study. The data were collected using a face-to-face interview questionnaire in Arabic. The data analysis was performed using Statistical Packages for Social Sciences SPSS version Continuous variables were expressed as the mean ± standard deviation SD or median [interquartile range IR ] as appropriate, and categorical variables were expressed as numbers percentages. An independent t -test was used to test for differences in the continuous variables, and a chi-square analysis was used to test for differences in the categorical variables. Of the patients included in the study, One hundred thirty patients The clinical characteristics of the participants are shown in Table 1. Hypoglycemia unawareness was not dependent on age, gender, duration of diabetes, duration of insulin therapy, HbA1c, frequency of blood glucose monitoring, or microvascular complications of diabetes. In addition, we did not find differences in HU between patients receiving insulin alone and those receiving both insulin and other hypoglycemic agents Table 2. When HU was evaluated with the modified Pedersen-Bjergaard method, the prevalence was In the current study, the prevalence of HU as assessed by the Clarke questionnaire score was This result is consistent with the results of many previous studies 11 — 13 but higher than reported in Jordan, where the prevalence of HU in patients with insulin-treated T2DM was When HU was evaluated by the modified Pedersen-Bjergaard method, a much higher prevalence of HU was observed The Pedersen-Bjergaard method tends to overestimate the prevalence of HU as documented previously by Geddes et al. A higher prevalence of HU was reported in T2DM patients from Turkey The factors reported to affect HU are not consistent among different studies, and some factors that were demonstrated to increase the risk for HU in some studies were not confirmed in others. However, long diabetes duration and strict blood sugar control are the most commonly reported factors that raise the risk of HU Nevertheless, in the present study, patients with HU had disease durations and HbA1c levels similar to those of aware subjects, findings that were also documented in other studies However, some studies found that patients with HU have higher HbA1c values Relaxing the glycemic target in patients with HU could explain the higher HbA1c values in those patients. Similarly, Murata et al. found that inadequate knowledge of diabetes is a risk factor for HU in type 2 diabetes Alanazi et al. also found that poor awareness of hypoglycemic attacks was observed among Another local study found that Diabetes education is a crucial key in diabetes management and should be a continuous process to improve blood glucose control, avoid hypoglycemia, and reduce diabetic complications. In the current study, we found that macrovascular complications of diabetes, specifically previous stroke and ischemic heart disease, are associated with increased risk for HU, whereas diabetic neuropathy and other microvascular complications of diabetes are not. Contrary to these results, Murata et al. found that stroke had no effect on hypoglycemia awareness, and intriguingly, the presence of microvascular complications of diabetes was associated with less risk for HU The findings from previous studies revealed that a significant number of patients with T1DM and T2DM were reluctant to discuss their hypoglycemia with their healthcare provider HCP. There could be many reasons for such a dangerous attitude, including implications for employment, fear of losing driving privileges, or concerns that it discloses poor glycemic control to the HCP 15 — In view of these findings along with the great risk of hypoglycemia associated with HU, regular screening for HU is a crucial element of diabetes care. For insulin-treated patients with HU, they are advised to raise their glycemic targets to strictly avoid hypoglycemia for at least several weeks in order to partially reverse hypoglycemia unawareness and reduce the risk of future episodes. However, we used two validated questionnaires commonly used in other studies for assessing HU 7 , 9. A further limitation of our study is that it was conducted only in one area of Saudi Arabia, so it may not be applicable to other Saudi populations. Despite these limitations, our findings provide valuable insights into HU in KSA. In addition, this study is among the few studies that investigated HU in Saudi Arabian insulin-treated diabetic patients. The study also provides valuable information on the association between HU and diabetes education. Further research is needed to confirm and extend our results. In addition, interventions to improve HU should also be explored. Despite the advances in insulin formulations and technologies used to control diabetes, HU continues to affect a significant proportion of patients with diabetes on insulin. Poor diabetes knowledge is a major risk factor for HU. Structured education for effective self-management of diabetes and screening for impaired awareness of hypoglycemia are of utmost importance to improve glycemic control and reduce the risk of hypoglycemia. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. EA conceptualized the idea of the research, and wrote the manuscript. AS was responsible for the literature search and provided research materials. SB collected and organized the data and references and provided logistic support. AA was responsible for data collection. All authors contributed to the article and approved the submitted version. We would like to express our deep and sincere gratitude to the medical students who helped with the data collection. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care 36 5 — doi: PubMed Abstract CrossRef Full Text Google Scholar. Martín-Timón I, Del Cañizo-Gómez FJ. Mechanisms of hypoglycemia unawareness and implications in diabetic patients. World J Diabetes 6 7 — Al-Agha AE, Alafif M, Abd-Elhameed IA. Glycemic control, complications, and associated autoimmune diseases in children and adolescents with type 1 diabetes in Jeddah, Saudi Arabia. Saudi Med J 36 1 Hassounah G, Abdullah Aljohani AE, Al Sharhani R, Al Aljoulni M, Robert AA, Al Goudah AH, et al. Prevalence of impaired awareness of hypoglycemia and its risk factors among patients with type 1 diabetes in Saudi Arabia. Diabetes Metab Syndr 16 1 Bakatselos SO. Hypoglycemia unawareness. Diabetes Res Clin Pract 93 SUPPL. Ahmed B, Khan MN. Hypoglycemia: its effect on patients with diabetes. World Fam Med 17 9 — CrossRef Full Text Google Scholar. You may be eligible for this study if: You have had at least one 1 episode of SEVERE hypoglycemia in the past 3 years, have reduced awareness of hypoglycemia, and are qualified as a candidate for pancreas transplant. Study involves Islet cell transplant procedure in interventional radiology with inpatient stay to stabilize glucose. Follow up with 29 study visits over 1 year following the transplant. In This Section. Are you a type 1 diabetic with hypoglycemic unawareness? UVA Tracking. Principal Investigator. Contact Email. |
| Hypoglycemia (Low Blood Glucose) | A study using fMRI reported rssearch functional connectivity Hypoglycemix brain regions that Nutritional support for peak performance been implicated in Carbohydrates and Fertility Micronutrient absorption of feeding behavior including the basal ganglia, Hyypoglycemic, and prefrontal cortex are altered in individuals with T1DM Diabetes Med 7 8 —7. Effects of a selective serotonin reuptake inhibitor, fluoxetine, on counterregulatory responses to hypoglycemia in healthy individuals. Diabetes, Obes. Amitriptyline and asymptomatic hypoglycemia. Copyright © Macon, Devore, Lin, Music, Wooten, McMullen, Woodcox, Marksbury, Beckner, Patel, Schoeder, Iles and Fisher. |
Video
What should I do with hypoglycemia unawareness?Hypoglycemic unawareness research -
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. 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. One hundred thirty patients The clinical characteristics of the participants are shown in Table 1.
Hypoglycemia unawareness was not dependent on age, gender, duration of diabetes, duration of insulin therapy, HbA1c, frequency of blood glucose monitoring, or microvascular complications of diabetes.
In addition, we did not find differences in HU between patients receiving insulin alone and those receiving both insulin and other hypoglycemic agents Table 2.
When HU was evaluated with the modified Pedersen-Bjergaard method, the prevalence was In the current study, the prevalence of HU as assessed by the Clarke questionnaire score was This result is consistent with the results of many previous studies 11 — 13 but higher than reported in Jordan, where the prevalence of HU in patients with insulin-treated T2DM was When HU was evaluated by the modified Pedersen-Bjergaard method, a much higher prevalence of HU was observed The Pedersen-Bjergaard method tends to overestimate the prevalence of HU as documented previously by Geddes et al.
A higher prevalence of HU was reported in T2DM patients from Turkey The factors reported to affect HU are not consistent among different studies, and some factors that were demonstrated to increase the risk for HU in some studies were not confirmed in others.
However, long diabetes duration and strict blood sugar control are the most commonly reported factors that raise the risk of HU Nevertheless, in the present study, patients with HU had disease durations and HbA1c levels similar to those of aware subjects, findings that were also documented in other studies However, some studies found that patients with HU have higher HbA1c values Relaxing the glycemic target in patients with HU could explain the higher HbA1c values in those patients.
Similarly, Murata et al. found that inadequate knowledge of diabetes is a risk factor for HU in type 2 diabetes Alanazi et al. also found that poor awareness of hypoglycemic attacks was observed among Another local study found that Diabetes education is a crucial key in diabetes management and should be a continuous process to improve blood glucose control, avoid hypoglycemia, and reduce diabetic complications.
In the current study, we found that macrovascular complications of diabetes, specifically previous stroke and ischemic heart disease, are associated with increased risk for HU, whereas diabetic neuropathy and other microvascular complications of diabetes are not.
Contrary to these results, Murata et al. found that stroke had no effect on hypoglycemia awareness, and intriguingly, the presence of microvascular complications of diabetes was associated with less risk for HU The findings from previous studies revealed that a significant number of patients with T1DM and T2DM were reluctant to discuss their hypoglycemia with their healthcare provider HCP.
There could be many reasons for such a dangerous attitude, including implications for employment, fear of losing driving privileges, or concerns that it discloses poor glycemic control to the HCP 15 — In view of these findings along with the great risk of hypoglycemia associated with HU, regular screening for HU is a crucial element of diabetes care.
For insulin-treated patients with HU, they are advised to raise their glycemic targets to strictly avoid hypoglycemia for at least several weeks in order to partially reverse hypoglycemia unawareness and reduce the risk of future episodes. However, we used two validated questionnaires commonly used in other studies for assessing HU 7 , 9.
A further limitation of our study is that it was conducted only in one area of Saudi Arabia, so it may not be applicable to other Saudi populations. Despite these limitations, our findings provide valuable insights into HU in KSA. In addition, this study is among the few studies that investigated HU in Saudi Arabian insulin-treated diabetic patients.
The study also provides valuable information on the association between HU and diabetes education. Further research is needed to confirm and extend our results.
In addition, interventions to improve HU should also be explored. Despite the advances in insulin formulations and technologies used to control diabetes, HU continues to affect a significant proportion of patients with diabetes on insulin. Poor diabetes knowledge is a major risk factor for HU.
Structured education for effective self-management of diabetes and screening for impaired awareness of hypoglycemia are of utmost importance to improve glycemic control and reduce the risk of hypoglycemia.
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. EA conceptualized the idea of the research, and wrote the manuscript. AS was responsible for the literature search and provided research materials.
SB collected and organized the data and references and provided logistic support. AA was responsible for data collection.
All authors contributed to the article and approved the submitted version. We would like to express our deep and sincere gratitude to the medical students who helped with the data collection. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society.
Diabetes Care 36 5 — doi: PubMed Abstract CrossRef Full Text Google Scholar. Martín-Timón I, Del Cañizo-Gómez FJ. Mechanisms of hypoglycemia unawareness and implications in diabetic patients. World J Diabetes 6 7 — Al-Agha AE, Alafif M, Abd-Elhameed IA.
Glycemic control, complications, and associated autoimmune diseases in children and adolescents with type 1 diabetes in Jeddah, Saudi Arabia. Saudi Med J 36 1 Hassounah G, Abdullah Aljohani AE, Al Sharhani R, Al Aljoulni M, Robert AA, Al Goudah AH, et al.
Prevalence of impaired awareness of hypoglycemia and its risk factors among patients with type 1 diabetes in Saudi Arabia. Diabetes Metab Syndr 16 1 Bakatselos SO. Hypoglycemia unawareness. Diabetes Res Clin Pract 93 SUPPL. Ahmed B, Khan MN. Hypoglycemia: its effect on patients with diabetes.
World Fam Med 17 9 — CrossRef Full Text Google Scholar. Gold AE, MacLeod KM, Frier BM. Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia. Diabetes Care 17 7 — Clarke WL, Cox DJ, Gonder-Frederick LA, Julian D, Schlundt D, Polonsky W.
Reduced awareness of hypoglycemia in adults with IDDM. A prospective study of hypoglycemic frequency and associated symptoms. Diabetes Care 18 4 — Pedersen-Bjergaard U, Agerholm-Larsen B, Pramming S, Hougaard P, Thorsteinsson B.
Activity of angiotensin-converting enzyme and risk of severe hypoglycaemia in type 1 diabetes mellitus. Lancet — Ortiz MR. Hypoglycemia in diabetes. Nurs Clin North Am 52 4 — Hepburn DA, Patrick AW, Eadington DW, Ewing D, Frier BM.
Unawareness of hypoglycaemia in insulin-treated diabetic patients: prevalence and relationship to autonomic neuropathy. Diabetes Med 7 8 —7. Geddes J, Wright RJ, Zammitt NN, Deary IJ, Frier BM. An evaluation of methods of assessing impaired awareness of hypoglycemia in type 1 diabetes.
Diabetes Care 30 7 — Ly TT, Gallego PH, Davis EA, Jones TW. Impaired awareness of hypoglycemia in a population-based sample of children and adolescents with type 1 diabetes. Diabetes Care 32 10 —6. Alkhatatbeh MJ, Abdalqader NA, Alqudah MAY. Impaired awareness of hypoglycaemia in insulin-treated type 2 diabetes mellitus.
Curr Diabetes Rev Kulzer B, Seitz L, Kern W. Real-world patient-reported rates of non-severe hypoglycaemic events in Germany.
John R. White; Micronutrient absorption Contribution of Medications to Hypoglycemia Rfsearch. Micronutrient absorption Spectr 1 April ; Hypoglycemic unawareness research unwaareness : 77— Hypoglycemia unawareness rezearch defined as the Micronutrient absorption of neuroglycopenia before Gut healing foods Hypoglycemic unawareness research of autonomic warning symptoms. However,much is known regarding risk factors, biochemical causes, and populations at greatest risk for the development of hypoglycemia unawareness. Less is known regarding the impact of medications on the development or recognition of this condition in patients with diabetes. Several medications are thought to worsen or promote hypoglycemia unawareness, whereas others may have an attenuating effect on the problem.
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