Hypoglycemia risk factors: Difference between revisions
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{{CMG}} {{AE}} {{MAD}} | {{CMG}} {{AE}} {{MAD}} | ||
==Overview== | ==Overview== | ||
Risk factors of hypoglycemia include diabetic patients with excessive [[insulin]] doses especially after missed meals or after exercise | Risk factors of hypoglycemia include diabetic patients with excessive [[insulin]] doses especially after missed meals or after exercise. Nocturnal fasting and [[alcohol]] intake are less common risk factors in diabetic patients. | ||
==Risk Factors== | ==Risk Factors== | ||
Risk factors of hypoglycemia include:<ref name="pmid19088155">{{cite journal| author=Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER et al.| title=Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. | journal=J Clin Endocrinol Metab | year= 2009 | volume= 94 | issue= 3 | pages= 709-28 | pmid=19088155 | doi=10.1210/jc.2008-1410 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19088155 }}</ref><ref name="pmid12766131">{{cite journal| author=Cryer PE, Davis SN, Shamoon H| title=Hypoglycemia in diabetes. | journal=Diabetes Care | year= 2003 | volume= 26 | issue= 6 | pages= 1902-12 | pmid=12766131 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12766131 }}</ref> | Risk factors of hypoglycemia include:<ref name="pmid19088155">{{cite journal| author=Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER et al.| title=Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. | journal=J Clin Endocrinol Metab | year= 2009 | volume= 94 | issue= 3 | pages= 709-28 | pmid=19088155 | doi=10.1210/jc.2008-1410 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19088155 }}</ref><ref name="pmid12766131">{{cite journal| author=Cryer PE, Davis SN, Shamoon H| title=Hypoglycemia in diabetes. | journal=Diabetes Care | year= 2003 | volume= 26 | issue= 6 | pages= 1902-12 | pmid=12766131 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12766131 }}</ref> | ||
* Excessive amounts of [[Insulin]] or [[insulin]] | * Excessive amounts of [[Insulin]] or [[insulin]] secretagogues drugs, inappropriate timing or type of administration | ||
* | * Decreased [[glucose]] intake (missed meals and overnight) | ||
* Increased [[glucose]] need during exercise | * Increased [[glucose]] need during exercise | ||
* | * Decreased [[endogenous]] [[glucose]] production after [[alcohol]] intake | ||
* [[Sensitivity]] to [[insulin]] is increased due to: | * [[Sensitivity]] to [[insulin]] is increased due to: | ||
** Weight loss | ** Weight loss | ||
** Improved [[glycemic control]] | ** Improved [[glycemic control]] | ||
** Physiologically in the middle of the night | ** Physiologically in the middle of the night | ||
* [[ | * [[Renal insufficiency|Renal failure]] may cause decreased [[Insulin]] [[Clearance (medicine)|clearance]] | ||
=== Risk factors for hypoglycemia-associated autonomic failure === | === Risk factors for hypoglycemia-associated autonomic failure === | ||
There are three | There are three defense mechanisms against hypoglycemia:<ref name="pmid12136392">{{cite journal| author=Cryer PE| title=Hypoglycaemia: the limiting factor in the glycaemic management of Type I and Type II diabetes. | journal=Diabetologia | year= 2002 | volume= 45 | issue= 7 | pages= 937-48 | pmid=12136392 | doi=10.1007/s00125-002-0822-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12136392 }}</ref><ref name="pmid15163777">{{cite journal| author=Cryer PE| title=Diverse causes of hypoglycemia-associated autonomic failure in diabetes. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 22 | pages= 2272-9 | pmid=15163777 | doi=10.1056/NEJMra031354 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15163777 }}</ref> | ||
* Decrease [[insulin]] levels | * Decrease in [[insulin]] levels | ||
* Increase [[glucagon]] production | * Increase in [[glucagon]] production | ||
* Increase [[epinephrine]] levels | * Increase in [[epinephrine]] levels | ||
Failure of any of these | Failure of any of these defense mechanisms increase the chance of hypoglycemia. This occurs rapidly in [[Diabetes mellitus type 1|type 1 diabetes]] and more gradually in [[Diabetes mellitus type 2|type 2 diabetes]] mainly due to:<ref name="pmid19033403">{{cite journal| author=Cryer PE| title=The barrier of hypoglycemia in diabetes. | journal=Diabetes | year= 2008 | volume= 57 | issue= 12 | pages= 3169-76 | pmid=19033403 | doi=10.2337/db08-1084 | pmc=2584119 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19033403 }}</ref> | ||
* Absolute endogenous [[insulin]] deficiency in [[Diabetes mellitus type 1|type1 DM]] | * Absolute endogenous [[insulin]] deficiency in [[Diabetes mellitus type 1|type1 DM]] | ||
* A history of severe hypoglycemia, hypoglycemia unawareness, or both | * A history of severe hypoglycemia, hypoglycemia unawareness, or both | ||
Latest revision as of 19:33, 15 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
Risk factors of hypoglycemia include diabetic patients with excessive insulin doses especially after missed meals or after exercise. Nocturnal fasting and alcohol intake are less common risk factors in diabetic patients.
Risk Factors
Risk factors of hypoglycemia include:[1][2]
- Excessive amounts of Insulin or insulin secretagogues drugs, inappropriate timing or type of administration
- Decreased glucose intake (missed meals and overnight)
- Increased glucose need during exercise
- Decreased endogenous glucose production after alcohol intake
- Sensitivity to insulin is increased due to:
- Weight loss
- Improved glycemic control
- Physiologically in the middle of the night
- Renal failure may cause decreased Insulin clearance
Risk factors for hypoglycemia-associated autonomic failure
There are three defense mechanisms against hypoglycemia:[3][4]
- Decrease in insulin levels
- Increase in glucagon production
- Increase in epinephrine levels
Failure of any of these defense mechanisms increase the chance of hypoglycemia. This occurs rapidly in type 1 diabetes and more gradually in type 2 diabetes mainly due to:[5]
- Absolute endogenous insulin deficiency in type1 DM
- A history of severe hypoglycemia, hypoglycemia unawareness, or both
- Aggressive glycemic therapy (lower HbA1C levels, lower glycemic goals)
References
- ↑ Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER; et al. (2009). "Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline". J Clin Endocrinol Metab. 94 (3): 709–28. doi:10.1210/jc.2008-1410. PMID 19088155.
- ↑ Cryer PE, Davis SN, Shamoon H (2003). "Hypoglycemia in diabetes". Diabetes Care. 26 (6): 1902–12. PMID 12766131.
- ↑ Cryer PE (2002). "Hypoglycaemia: the limiting factor in the glycaemic management of Type I and Type II diabetes". Diabetologia. 45 (7): 937–48. doi:10.1007/s00125-002-0822-9. PMID 12136392.
- ↑ Cryer PE (2004). "Diverse causes of hypoglycemia-associated autonomic failure in diabetes". N Engl J Med. 350 (22): 2272–9. doi:10.1056/NEJMra031354. PMID 15163777.
- ↑ Cryer PE (2008). "The barrier of hypoglycemia in diabetes". Diabetes. 57 (12): 3169–76. doi:10.2337/db08-1084. PMC 2584119. PMID 19033403.