Management of Hypoglycemia in Adults with Type 1 Diabetes in Real-Life Condition

Abstract

<b><i>Introduction:</i></b> Hypoglycemia is the most common acute complication in individuals with type 1 diabetes (T1D). Episodes of mild or moderate hypoglycemia should be treated in adults with a dose of around 15–20 g fast-acting carbohydrates. However, this self-treatment of hypoglycemia in real-life condition is not well documented. <b><i>Objective:</i></b> The aim of this study wasto determine the characteristics of hypoglycemia treatment in adults with T1D in a prospective study design. <b><i>Methods:</i></b> Individuals with T1D were advised to record information related to hypoglycemia episodes for a period of 14 days. Quantity and quality (including glycemic index [GI] and glycemic load) of carbohydrates consumed in every hypoglycemia episode and others factors related with hypoglycemia such as physical activity, fear of hypoglycemia, or hypoglycemia awareness were analyzed. <b><i>Results:</i></b> A total of 93 individuals (36.5 ± 16.2 years old, BMI of 24.9 ± 3.8 kg/m<sup>2</sup>, diabetes duration of 14.9 ± 10.4 years, and HbA1c levels of 7.3 ± 0.8%) were included in the study. A total of 483 episodes of mild or moderate hypoglycemia were reported, which supposed on average 2.7 ± 2.0 episodes a week. The quantity of carbohydrates consumed in all episodes of hypoglycemia was 25.9 ± 9.2 g. GI of food consumed in all episodes of hypoglycemia was classified as low (53.9 ± 8.3). Overtreatment of hypoglycemia, defined as ingestion of more than 20 g of carbohydrates, occurred in 50.3% of hypoglycemic episodes; even 22.3% of these episodes were treated with more than 30 g of carbohydrates. Fruit juice was the most popular option, chosen in almost 70% of the events. In addition, we observed other moderate or low GI foods such as milk, bread, cookies, and bakery products among the most consumed foods. <b><i>Conclusion:</i></b> A majority of the studied individuals with T1D does not manage hypoglycemia according to current American Diabetes Association guidelines, in most cases by overtreating, choosing foods with low glycemic effect, and not varying the dose of carbohydrates, depending on the physical activity performed.

Is intake of fruit juice useful in exercise-induced hypoglycemia prevention in individuals with type 1 diabetes mellitus?

“…According to the American Diabetes Association's (ADA) recommendations, individuals with T1DM should choose rapidly-acting glucose to treat severe hypoglycemia (18). Recently published data show that fruit juice was the most frequently chosen option among persons with T1DM in hypoglycemic events (70%) (19).…”

Post-Hypoglycemic hyperglycemia are highly relevant markers for stratification of glycemic variability and partial remission status of pediatric patients with new-onset type 1 diabetes

“…Though rarely life-threatening [ 8 ], children experience on average three symptomatic hypoglycemic events per week that commonly require external intervention (i.e., providing oral carbohydrates or glucagon analogs) [ 8 ]. Additionally, as hypoglycemia is an acute, stressful and unpleasant event for both the child and the parents, these events may lead to excessive carbohydrate intake followed by acute hyperglycemia and, more globally, increased glycemic variability [ 12 ]. This highlights hypoglycemia as a potential trigger of hyperglycemic excursions and the need for therapeutic education focusing on individual profiles of glycemic variation.…”

Preference for high-carbohydrate foods does not change for children and adolescents in insulin-induced hypoglycemia

“…1 Despite clear guidance on recommended treatment, 2 people with diabetes can struggle to self-treat a hypoglycemic episode correctly; some develop hyperglycemia due to overeating, and others experience severe, prolonged hypoglycemia by selecting foods that slow absorption of glucose (eg, peanut butter). [3][4][5] Consequences of inappropriately and inadequately treated hypoglycemia can include seizures, coma, and death.…”

“…Despite advances in technologies designed to facilitate the monitoring and management of blood glucose in patients with diabetes mellitus, avoidance of hypoglycemia continues to be a challenge for patients with type 1, and those with insulin-dependent type 2 diabetes 1. Despite clear guidance on recommended treatment,2 people with diabetes can struggle to self-treat a hypoglycemic episode correctly; some develop hyperglycemia due to overeating, and others experience severe, prolonged hypoglycemia by selecting foods that slow absorption of glucose (eg, peanut butter) 3–5. Consequences of inappropriately and inadequately treated hypoglycemia can include seizures, coma, and death.…”