Hypoglycemia primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Primary Prevention
Patient education:[1]
- Ability to recognize early symptoms.
- Frequent self-monitoring of blood glucose:[2]
- continuous glucose monitoring may facilitate glycemic control.
- It shlould be more restrict for patients using alcohol and B-blockers.
- Glycemic control can minimize complications and prevent cardiovascular events.[3]
- Long acting insulin mixed with short acting ones as the pre-meal bolus insulin reduce the risk of hypoglycemia especially before meals and sleep.
- Bedtime snacks are the best way to prevent nocturnal hypoglycemia.[4]
- Sensor-augmented insulin pumps . [5]
Exercise can cause hypoglycemia in patients with insulin-deficient diabetes.[6]
- frequent SMBG
- reduced insulin doses
- carbohydrate ingestion
The most effective means of preventing further episodes of hypoglycemia depends on the cause:
- The risk of further episodes of diabetic hypoglycemia can often be reduced by lowering the dose of insulin or other medications, or by more meticulous attention to blood sugar balance during unusual hours, higher levels of exercise, or alcohol intake.
- Many of the inborn errors of metabolism require avoidance or shortening of fasting intervals, or extra carbohydrates.
- For the more severe disorders, such as type 1 glycogen storage disease, this may be supplied in the form of cornstarch every few hours or by continuous gastric infusion.
- Hypoglycemia due to dumping syndrome: mixed diets including fat and protein with carbohydrates may slow digestion and reduce early insulin secretion and glucosidase inhibitor which slows starch digestion.
- Reactive hypoglycemia: changing eating patterns: smaller meals, avoiding excessive sugar and mixed meals.
References
- ↑ de Zoysa N, Rogers H, Stadler M, Gianfrancesco C, Beveridge S, Britneff E; et al. (2014). "A psychoeducational program to restore hypoglycemia awareness: the DAFNE-HART pilot study". Diabetes Care. 37 (3): 863–6. doi:10.2337/dc13-1245. PMID 24319119.
- ↑ Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L; et al. (2013). "Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society". J Clin Endocrinol Metab. 98 (5): 1845–59. doi:10.1210/jc.2012-4127. PMID 23589524.
- ↑ Cryer PE (2014). "Glycemic goals in diabetes: trade-off between glycemic control and iatrogenic hypoglycemia". Diabetes. 63 (7): 2188–95. doi:10.2337/db14-0059. PMID 24962915.
- ↑ Gray RO, Butler PC, Beers TR, Kryshak EJ, Rizza RA (1996). "Comparison of the ability of bread versus bread plus meat to treat and prevent subsequent hypoglycemia in patients with insulin-dependent diabetes mellitus". J Clin Endocrinol Metab. 81 (4): 1508–11. doi:10.1210/jcem.81.4.8636359. PMID 8636359.
- ↑ Bergenstal RM, Klonoff DC, Garg SK, Bode BW, Meredith M, Slover RH; et al. (2013). "Threshold-based insulin-pump interruption for reduction of hypoglycemia". N Engl J Med. 369 (3): 224–32. doi:10.1056/NEJMoa1303576. PMID 23789889. Review in: Ann Intern Med. 2013 Sep 17;159(6):JC7
- ↑ Cryer PE, Davis SN, Shamoon H (2003). "Hypoglycemia in diabetes". Diabetes Care. 26 (6): 1902–12. PMID 12766131.