Hypoglycemia risk factors: Difference between revisions
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=== 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 | * Excessive amounts of [[Insulin]] or insulin secretagogue doses, inappropriate timing of administration, or administration of the wrong type of drug. | ||
* | * Decrease exogenous [[glucose]] delivery (''e.g.'' after missed meals and during the overnight fast). | ||
* | * Increased [[glucose]] utilization (''e.g.'' during exercise). | ||
* | * Decrease endogenous glucose production (''e.g.'' after [[alcohol]] ingestion). | ||
* Sensitivity to [[insulin]] is increased | * Sensitivity to [[insulin]] is increased due to: | ||
* [[Insulin]] [[Clearance (medicine)|clearance]] | ** Weight loss | ||
** Increase in regular exercise | |||
** Improved glycemic control | |||
** Physiologically in the middle of the night | |||
* Decreased [[Insulin]] [[Clearance (medicine)|clearance]] due to [[renal failure]]. | |||
=== Risk factors for hypoglycemia-associated autonomic failure === | === Risk factors for hypoglycemia-associated autonomic failure === | ||
There are three defenses against hypoglycemia: | |||
* Decrease [[insulin]] levels in blood | |||
* Increase glucagon production | |||
* Increase [[epinephrine]] levels in body | |||
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 | ||
* A history of severe hypoglycemia, hypoglycemia unawareness, or both | * A history of severe hypoglycemia, hypoglycemia unawareness, or both | ||
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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]
- Excessive amounts of Insulin or insulin secretagogue doses, inappropriate timing of administration, or administration of the wrong type of drug.
- Decrease exogenous glucose delivery (e.g. after missed meals and during the overnight fast).
- Increased glucose utilization (e.g. during exercise).
- Decrease endogenous glucose production (e.g. after alcohol ingestion).
- Sensitivity to insulin is increased due to:
- Weight loss
- Increase in regular exercise
- Improved glycemic control
- Physiologically in the middle of the night
- Decreased Insulin clearance due to renal failure.
Risk factors for hypoglycemia-associated autonomic failure
There are three defenses against hypoglycemia:
- Decrease insulin levels in blood
- Increase glucagon production
- Increase epinephrine levels in body
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:[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.