Hypoglycemia: An Excuse for Poor Glycemic Control?

Ma, Saleh; Grunberger, George

doi:10.2337/diaclin.19.4.161

Cited by 14 publications

(6 citation statements)

References 41 publications

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“…Fear of hypoglycemia can also be a major barrier to achieving optimal glycemic control [40]. Hypoglycemia can give rise to high insecurity; even if one is emotionally prepared for the complication, the thought of future episodes can cause fearful and disturbed feelings.…”

Section: Fear Of Side Effects/complicationsmentioning

confidence: 98%

Psychological insulin resistance: patient beliefs and implications for diabetes management

et al. 2008

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PIR is complex and multifaceted. It plays an important, although often ignored, role in diabetes management. Assisting health care professionals in better understanding PIR from the patient's perspective should result in improved treatment outcomes. By tailoring treatments to patients' PIR, clinicians may be better able to help their patients begin insulin treatment sooner and improve compliance, thus facilitating target glycemic control.

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Section: Fear Of Side Effects/complicationsmentioning

confidence: 98%

Psychological insulin resistance: patient beliefs and implications for diabetes management

et al. 2008

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“…Hypoglycaemia is the most frequent complication of diabetes and occurs more frequently in patients on intensive insulin regimens. 3 The conventional risk factors for hypoglycaemia are based on the premise that absolute or relative insulin excess is the sole determinant of risk. 4 Hypoglycaemia is usually the result of a mismatch between insulin action, food ingestion and energy expenditure.…”

Section: Discussionmentioning

confidence: 99%

Severe recurrent hypoglycaemia following discontinuation of olanzapine

Steven

Nayar²

2011

Acute Med

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Severe hypoglycaemia is a diagnostic challenge.1 It is often explained by mismatch between insulin doses, food ingestion and exercise. Recurrent hypoglycaemia can indicate underlying medical problems. Drug related events usually concern insulin or sulphonylureas. However, withdrawal of drugs which can cause insulin resistance can be causative if insulin or sulphonylureas continue.2We report the case of an insulin-treated patient who presented with severe recurrent hypoglycaemia. After exclusion of secondary causes of hypoglycaemia it was established that at the time of diagnosis of diabetes he had been taking olanzapine. This had subsequently been discontinued. Olanzapine is recognised to cause diabetes and diabetic ketoacidosis. Our patient was able to discontinue insulin therapy.

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“…There has been a disagreement about the correlation of hypothyroidism and hypoglycaemia 153, 154 . Hypothyroidism is thought to cause hypoglycaemia through the reduction of gluconeogenesis in skeletal muscle and in adipose tissue and impairment of glycogenolysis 155, 156 …”

Section: Hypoglycaemia and Endocrine Disordersmentioning

confidence: 99%

Hypoglycaemia and its management in primary care setting

Ibrahim¹,

Baker

Cahn³

et al. 2020

Diabetes Metabolism Res

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Hypoglycaemia is common in patients with type 1 diabetes and type 2 diabetes and constitutes a major limiting factor in achieving glycaemic control among people with diabetes. While hypoglycaemia is defined as a blood glucose level under 70 mg/dL (3.9 mmol/L), symptoms may occur at higher blood glucose levels in individuals with poor glycaemic control. Severe hypoglycaemia is defined as an episode requiring the assistance of another person to actively administer carbohydrate, glucagon, or take other corrective actions to assure neurologic recovery. Hypoglycaemia is the most important safety outcome in clinical studies of glucose lowering agents. The American Diabetes Association Standards of Medical Care recommends that a management protocol for hypoglycaemia should be designed and implemented by every hospital, along with a clear prevention and treatment plan. A tailored approach, using clinical and pathophysiologic disease stratification, can help individualize glycaemic goals and promote new therapies to improve quality of life of patients. Data from recent large clinical trials reported low risk of hypoglycaemic events with the use of newer anti‐diabetic drugs. Increased hypoglycaemia risk is observed with the use of insulin and/or sulphonylureas. Vulnerable patients with T2D at dual risk of severe hypoglycaemia and cardiovascular outcomes show features of “frailty.” Many of such patients may be better treated by the use of GLP‐1 receptor agonists or SGLT2 inhibitors rather than insulin. Continuous glucose monitoring (CGM) should be considered for all individuals with increased risk for hypoglycaemia, impaired hypoglycaemia awareness, frequent nocturnal hypoglycaemia and with history of severe hypoglycaemia. Patients with impaired awareness of hypoglycaemia benefit from real‐time CGM. The diabetes educator is an invaluable resource and can devote the time needed to thoroughly educate the individual to reduce the risk of hypoglycaemia and integrate the information within the entire construct of diabetes self‐management. Conversations about hypoglycaemia facilitated by a healthcare professional may reduce the burden and fear of hypoglycaemia among patients with diabetes and their family members. Optimizing insulin doses and carbohydrate intake, in addition to a short warm up before or after the physical activity sessions may help avoiding hypoglycaemia. Several therapeutic considerations are important to reduce hypoglycaemia risk during pregnancy including administration of rapid‐acting insulin analogues rather than human insulin, pre‐conception initiation of insulin analogues, and immediate postpartum insulin dose reduction.

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Hypoglycemia: An Excuse for Poor Glycemic Control?

Cited by 14 publications

References 41 publications

Psychological insulin resistance: patient beliefs and implications for diabetes management

Psychological insulin resistance: patient beliefs and implications for diabetes management

Severe recurrent hypoglycaemia following discontinuation of olanzapine

Hypoglycaemia and its management in primary care setting

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