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> === | === 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> === | ||
* Insulin or insulin secretagogue doses are excessive, ill-timed, or of the wrong type. | * [[Insulin]] or insulin secretagogue doses are excessive, ill-timed, or of the wrong type. | ||
* Exogenous glucose delivery is decreased (''e.g.'' after missed meals and during the overnight fast). | * Exogenous [[glucose]] delivery is decreased (''e.g.'' after missed meals and during the overnight fast). | ||
* Glucose utilization is increased (''e.g.'' during exercise). | * Glucose utilization is increased (''e.g.'' during exercise). | ||
* Endogenous glucose production is decreased (''e.g.'' after alcohol ingestion). | * Endogenous glucose production is decreased (''e.g.'' after [[alcohol]] ingestion). | ||
* Sensitivity to insulin is increased | * Sensitivity to [[insulin]] is increased after weight loss, an increase in regular exercise or improved glycemic control, and in the middle of the night. | ||
* [[Insulin]] [[Clearance (medicine)|clearance]] is decreased with [[renal failure]]. | |||
* Insulin clearance is decreased | |||
=== Risk factors for hypoglycemia-associated autonomic failure === | === Risk factors for hypoglycemia-associated autonomic failure === | ||
There are three defences against hypoglycemia; decrease of insulin. increase of glucagon and increase of epinephrine. Failure of any of these defenses increase chances of hypoglycemia. This occurs rapidly in type 1 diabetes and more gradually in type 2 diabetes.<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> | * There are three defences against hypoglycemia; decrease of [[insulin]]. increase of glucagon and increase of [[epinephrine]]. 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]].<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 | |||
* A history of severe hypoglycemia, hypoglycemia unawareness, or both | * Absolute endogenous [[insulin]] deficiency | ||
* Aggressive glycemic therapy (lower HbA1C levels, lower glycemic goals) | * A history of severe hypoglycemia, hypoglycemia unawareness, or both | ||
* Aggressive glycemic therapy (lower [[HbA1C]] levels, lower glycemic goals) | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 14:37, 25 August 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 or with alcohol. Absolute endogenous insulin deficiency is another risk factor.
Risk Factors
Risk factors of hypoglycemia include:[1]
- Insulin or insulin secretagogue doses are excessive, ill-timed, or of the wrong type.
- Exogenous glucose delivery is decreased (e.g. after missed meals and during the overnight fast).
- Glucose utilization is increased (e.g. during exercise).
- Endogenous glucose production is decreased (e.g. after alcohol ingestion).
- Sensitivity to insulin is increased after weight loss, an increase in regular exercise or improved glycemic control, and in the middle of the night.
- Insulin clearance is decreased with renal failure.
Risk factors for hypoglycemia-associated autonomic failure
- There are three defences against hypoglycemia; decrease of insulin. increase of glucagon and increase of epinephrine. Failure of any of these defenses increase chances of hypoglycemia. This occurs rapidly in type 1 diabetes and more gradually in type 2 diabetes.[2]
- Absolute endogenous insulin deficiency
- 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 (2008). "The barrier of hypoglycemia in diabetes". Diabetes. 57 (12): 3169–76. doi:10.2337/db08-1084. PMC 2584119. PMID 19033403.