Hypoglycemia in Type 1 and Type 2 Diabetes: Physiology, Pathophysiology,and Management

Abstract

IN BRIEF The threat and incidence of hypoglycemia is the major limiting factor in intensive glycemic control for both type 1 and type 2 diabetes. This article reviews the physiology of the normal counterregulatory responses to hypoglycemia and the deficient counterregulatory defenses that occur in patients with diabetes. Treatment paradigms for establishing good glycemic control while limiting hypoglycemia are also discussed.

Does better disease management in primary care reduce hospital costs? Evidence from English primary care

“…For example, disease management of diabetic patients is aimed at reducing blood sugar levels and should therefore reduce emergency admissions for acute hyperglycaemic complications. But excessively aggressive management of blood sugar can increase the risk of admissions for hypoglycaemic coma (Briscoe and Davis, 2006). The targeting of patients with specified chronic conditions may also divert GP efforts away from other types of patients and increase their risk of hospitalization.…”

Nurses' Knowledge of Hypoglycemia and Treatment in the Adult Hospitalized Patiend with Diabetes: A Quality Improvement Project

“…Normally, the body's response to hypoglycemia consists of suppression of insulin release and secretion of glucagon and pancreatic polypeptides from the pancreas and the release of epinephrine, norepinephrine, cortisol and growth hormone (Briscoe & Davis, 2006). Glucagon and epinephrine are the primary hormones that protect the human body against hypoglycemia.…”

“…The symptoms of hypoglycemia can be categorized as neurogenic or neuroglycopenic (Briscoe & Davis, 2006). Neurogenic or autonomic symptoms are triggered by an actively falling glucose, which causes the individual to realize they are having a hypoglycemic event.…”

“…Non-immune, or idiopathic diabetes, is much less common and occurs secondary to other diseases with varying degrees of insulin deficiency in which no autoimmunity is present (Zaccardi et al). (Briscoe & Davis, 2006). The human brain depends on a continuous supply of glucose because it is unable to store this primary source of energy, so it is often the first organ to be affected by hypoglycemia.…”

Hypoglycemia Prevention in Closed-Loop Artificial Pancreas for Patients with Type 1 Diabetes

“…In T1DM, insulin deficiency is often accompanied by the loss of glucagon secretory response to hypoglycemia. Furthermore, insulin therapy causes even more degradation in the functionality of other counterregulatory hormones (Briscoe & Davis (2006)), and consequently, results in higher possibility for hypoglycemic risk. Different artificial pancreas studies have demonstrated that glucagon infusion significantly reduces the risk of insulin-induced hypoglycemia in T1DM (Castle et al (2010);El-Khatib et al (2009;; Ward et al (2008)).…”