HYPOGLYCEMIA

Hypoglycemia are the most common complications that occur in patients with diabetes who are treated with insulin

Clinical features :
- Neuroglycopenia (insufficient glucose for normal CNS function) :
mental confusion, fatigue, seizure, stupor, coma, death
- Neurogenic (autonomic) :
adrenergic (tachycardia, palpitations, sweating, tremulousness) and parasympathetic (nausea, hunger)

Risk factors :
- Insulin doses are excessive
- Influx of exogenous glucose is reduced (during an overnight fast / missed meals)
- Insulin-independent glucose utilization is increased (during exercise)
- Insulin sensitivity is increased (intensive therapy, in the middle of the night, late after exercise, increased fitness,
weight loss)
- Endogenous glucose production is reduced
- Insulin clearance is reduced

Counterregulatory responses to hypoglycemia

1. Normal counterregulation
When plasma glucose is low (falls below 70 mg/dL hormonal responses tend to begin glucagon &
epinephrine acts to counterregulate hypoglycemia
Glucagon is considered the 1st line of defense and epinephrine is to provide a backup system

2. Defective counterregulation in diabetes

For unexplained reasons, patient with type 1 diabetes uniformly lose their ability to secrete glucagon in
response to acute insulin-induced hypoglycemia

Hypoglycemia unawareness
- Refers to a loss of the warning symptoms that alert individuals to the presence of hypoglycemia
- Periods of relative or absolute therapeutic insulin excess, in the setting of absent glucose response lead to
episodes of iatrogenic hypoglycemia failure of the sympathetic nerve system to respond to hypoglycemiaz

Management
- Increase self monitoring blood glucose
- Eating frequent small snacks
- Reducing size of insulin doses