Hypoglycaemia in Diabetes

In diabetes, hypoglycaemia for the most part emerges as a result of pharmacologic treatment that causes blood glucose levels to drop underneath the normal range. Whereas mild hypoglycaemia usually resolves with incite ingestion of carbohydrates, more often reduced glucose levels can impede cognitive function, and even threaten life.

Nocturnal hypoglycaemia poses a specific challenge because the sleeping patient isn't in a position to intervene and numerous episodes are asymptomatic. Repeated exposure to nocturnal hypoglycaemia can limit counterregulatory mechanisms, with possibly serious clinical consequences.

Hypoglycaemia in diabetes typically happens as a result of therapeutic treatment, particularly with insulin, glinides or sulfonylureas (SUs). Risk factors for hypoglycaemia includes Aggressive treatment of glycaemia, HbA1C < 6.5%* (except in youth), High glucose variability (in older adults), Long duration of diabetes, Renal impairment, Duration of insulin therapy, Advanced age, Cognitive impairment, Depression. In addition, insulin-related factors and specific behaviours may influence the risk of nocturnal hypoglycaemia. Risk factors includes: Missed meal, alcohol consumption, strenuous, dose of basal insulin too high, too much rapid-acting insulin to correct high glucose, premix or short-acting insulin before dinner, NPH insulin (isophane) in the evening.

An episode of severe hypoglycaemia can lead to loss of consciousness, confusion and seizures, with a concomitant increase in the risk of injuries, falls and hospitalisation. Nocturnal hypoglycaemia will leads to disturbed sleep. Fear of hypoglycaemia, in turn, can prevent adherence to medical treatment.

Impaired awareness of hypoglycaemia (IAH) may be a reduced ability to see the onset of hypoglycaemia. IAH emerges when rehashed episodes of hypoglycaemia raise the glycaemic limit for symptom generation. Symptoms that would make individuals mindful of approaching hypoglycaemia, such as sweating or anxiety, no longer occur above the new limit. In addition, IAH increases people’s dependence on others to treat their. Scrupulous avoidance of hypoglycaemia can invert IAH, though in spite of the fact that this procedure runs the chance of compromising glycaemic control.

Symptoms of non-severe hypoglycaemia can be treated with 15 g fast-acting carbohydrate, such as a few small sweets or sweetened drink or cup of milk, juice. Treatment is additionally exhorted in asymptomatic patients with blood glucose in the alert range of (63 to 70 mmol/L). If glucose levels stay low after 15 minutes, treatment ought to be rehashed. In a conscious person, severe hypoglycaemia can be cured in a comparative manner with 20 g fast-acting carbohydrates. On the off chance that glucose remains low after 45 minutes, IV glucose can be considered if accessible. In an unconscious person, hypoglycaemia is treated with glucagon or with IV glucose.