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, nocturnal or with [[alcohol]]. Absolute endogenous [[insulin]] deficiency is another risk factor. | Risk factors of hypoglycemia include diabetic patients with excessive [[insulin]] doses especially after missed meals or after exercise, nocturnal or with [[alcohol]]. Absolute endogenous [[insulin]] deficiency is another risk factor. | ||
==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> | |||
* Excessive amounts of [[Insulin]] or [[insulin]]-inducing drugs, inappropriate timing or type of administration | |||
* Excessive amounts of [[Insulin]] or insulin | * Decrease [[glucose]] intake (missed meals and overnight) | ||
* Decrease | * Increased [[glucose]] need during exercise | ||
* Increased [[glucose]] | * Decrease [[endogenous]] [[glucose]] production after [[alcohol]] intake | ||
* Decrease endogenous glucose production | * [[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 failure]] due to decreased [[Insulin]] [[Clearance (medicine)|clearance]] | ||
=== Risk factors for hypoglycemia-associated autonomic failure === | === Risk factors for hypoglycemia-associated autonomic failure === | ||
There are three defenses against hypoglycemia: | There are three defenses 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> | ||
* Decrease [[insulin]] levels in blood | * Decrease [[insulin]] levels in [[blood]] | ||
* Increase glucagon production | * Increase [[glucagon]] production | ||
* Increase [[epinephrine]] levels | * Increase [[epinephrine]] levels | ||
Failure of any of these defenses increase chances 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> | Failure of any of these defenses increase chances 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 | * 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 | ||
* Aggressive glycemic therapy (lower [[HbA1C]] levels, lower glycemic goals) | * Aggressive glycemic therapy (lower [[HbA1C]] levels, lower glycemic goals) | ||
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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 or with alcohol. Absolute endogenous insulin deficiency is another risk factor.
Risk Factors
Risk factors of hypoglycemia include:[1][2]
- Excessive amounts of Insulin or insulin-inducing drugs, inappropriate timing or type of administration
- Decrease glucose intake (missed meals and overnight)
- Increased glucose need during exercise
- Decrease 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 due to decreased Insulin clearance
Risk factors for hypoglycemia-associated autonomic failure
There are three defenses against hypoglycemia:[3]
- Decrease insulin levels in blood
- Increase glucagon production
- Increase epinephrine levels
Failure of any of these defenses increase chances of hypoglycemia. This occurs rapidly in type 1 diabetes and more gradually in type 2 diabetes mainly due to:[4]
- 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 (2008). "The barrier of hypoglycemia in diabetes". Diabetes. 57 (12): 3169–76. doi:10.2337/db08-1084. PMC 2584119. PMID 19033403.