Symptoms of Acute Insulin-Induced Hypoglycemia in Humans With and Without IDDM: Factor-Analysis Approach

Hepburn, David; Deary, Ian J.; Frier, Brian M.; Patrick, A. W.; Quinn, Joe; Fisher, BM

doi:10.2337/diacare.14.11.949

Cited by 175 publications

(103 citation statements)

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“…Insulin dosages were adjusted whenever required. During both treatment periods patients recorded the severity and type of warning symptoms during a hypoglycaemic episode (defined as a measured blood glucose value lower than 3.5 mmol/l with or without symptoms) according to a modified, standardized questionnaire, attached to a diabetes diary [24,25]. At the end of the study patients' assessment of the new therapeutic regimen was made in terms of perceived burden and satisfaction.…”

Section: Subjects Materials and Methodsmentioning

confidence: 99%

“…Blood pressure and heart rate were measured automatically every 15 min during the test (Colin; Hayashi Komaki City, Japan). At intervals of 30 min the subjects were asked to complete a symptom questionnaire, where the symptoms related to hypoglycaemia were ranked on a linear analogue scale from 0 = none to 6 = very severe [24,25]. Symptoms such as warmness, palpitations, anxiety, tremor, sweating, shivering, hunger and blurred vision were considered as autonomic, whereas difficulty speaking, dizziness, weakness, double vision, tiredness, concentration problems, drowsiness and confusion were interpreted as neuroglycopenic.…”

Section: Subjects Materials and Methodsmentioning

confidence: 99%

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Substitution of night-time continuous subcutaneous insulin infusion therapy for bedtime NPH insulin in a multiple injection regimen improves counterregulatory hormonal responses and warning symptoms of hypoglycaemia in IDDM

et al. 1998

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Several recent studies have demonstrated that good glycaemic control reduces the risk of late diabetic complications such as retinopathy, nephropathy and neuropathy [1±3]. However, maintenance of good glycaemic control considerably increases the incidence of all degrees of hypoglycaemia [4]. The magnitude of this increase has been shown to be closely related to the achieved level of glycaemic control [4]. In patients with a diabetes duration of more than 15 years, in patients with strict glycaemic control and in those who previously experienced a severe hypoglycaemia blunted counterregulatory hormonal responses [5,6] and absence of autonomic warning symptoms to hypoglycaemia have been reported [7]. Hypoglycaemia unawareness, i. e. the inability to perceive consciously the onset of hypoglycaemia, may, among other factors, be induced by even mild episodes of hypoglycaemia, including nocturnal hypoglycaemia [8±10]. In well-regulated insulin-dependent diabetic (IDDM) patients nocturnal hypoglycaemia occurs once every 2±3 nights [11] and this incidence rate might even be an underestimation [12]. Probably the high incidence of nocturnal hypoglycaemia is mainly a consequence of the characteristics of the Diabetologia (1998) Summary In patients with insulin-dependent diabetes mellitus (IDDM) good glycaemic control confers an enhanced risk of hypoglycaemia. Nocturnal hypoglycaemia occurs frequently and contributes to the syndrome of hypoglycaemia unawareness. In order to avoid nocturnal hypoglycaemia we substituted night-time continuous subcutaneous insulin infusion (CSII) therapy in 14 patients with well-controlled IDDM using a multiple injection regimen for the more variable bedtime NPH insulin. During a stepwise hypoglycaemic clamp we studied the effect of this regimen on counterregulatory hormonal responses, warning symptoms and cognitive function. In addition, we investigated the incidence of daytime hypoglycaemia and the acceptability of night-time CSII treatment. CSII was associated with a lower frequency of hypoglycaemia (mean ± SEM): 16.1 ± 3.1 vs 23.6 ± 3.3) episodes during the last 6 weeks of treatment, p = 0.03 (CSII vs NPH)) with maintenance of good glycaemic control (HbA 1c 7.2 ± 0.2 vs 7.1 ± 0.2 %, p = 0.2). Hypoglycaemic thresholds for the growth hormone response and for autonomic symptoms were lower for CSII treatment than for NPH treatment. Of 14 patients 6 decided to continue with the nocturnal CSII treatment. In conclusion, nocturnal CSII improves warning symptoms and counterregulatory hormonal responses to hypoglycaemia and is an acceptable treatment strategy for patients suffering from hypoglycaemia unawareness, as demonstrated in this acute feasibility study. [Diabetologia (1998)

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Section: Subjects Materials and Methodsmentioning

confidence: 99%

Section: Subjects Materials and Methodsmentioning

confidence: 99%

Substitution of night-time continuous subcutaneous insulin infusion therapy for bedtime NPH insulin in a multiple injection regimen improves counterregulatory hormonal responses and warning symptoms of hypoglycaemia in IDDM

et al. 1998

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“…Autonomic symptoms were calculated from the sum of the scores assigned to sweat, shakiness, anxiety, hotness or heart pounding. Neuroglycopenic scores were calculated as the sum of the scores attributed to dizziness, difficulty in concentrating, confusion, irritability or blurred vision [11].…”

Section: Methodsmentioning

confidence: 99%

Brain function rescue effect of lactate following hypoglycaemia is not an adaptation process in both normal and Type I diabetic subjects

et al. 2000

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Patients with Type I (insulin-dependent) diabetes mellitus receiving intensified insulin therapy and having strict metabolic control are exposed to the risk of recurrent episodes of hypoglycaemia [1]. Defective counterregulatory and symptomatic responses to hypoglycaemia are responsible for reduced awareness of hypoglycaemia [2] which can aggravate cerebral dysfunction by increasing the occurrence and severity Diabetologia (2000) 43: 733±741Brain function rescue effect of lactate following hypoglycaemia is not an adaptation process in both normal and Type I diabetic subjects Abstract Aims/hypothesis. We have previously shown that lactate protects brain function during insulin-induced hypoglycaemia. An adaptation process could, however, not be excluded because the blood lactate increase preceded hypoglycaemia. Methods. We studied seven healthy volunteers and seven patients with Type I (insulin-dependent) diabetes mellitus with a hyperinsulinaemic (1.5 mUḱ g ±1´m in ±1 ) stepwise hypoglycaemic clamp (4.8 to 3.6, 3.0 and 2.8 mmo/l) with and without Na-lactate infusion (30 mmol´kg ±1´m in ±1 ) given after initiation of hypoglycaemic symptoms. Results. The glucose threshold for epinephrine response was similar (control subjects 3.2 0.1 vs 3.2 0.1, diabetic patients = 3.5 0.1 vs 3.5 0.1 mmol/l) in both studies. The magnitude of the response was, however, blunted by lactate infusion (AUC; control subjects 65 28 vs 314 55 nmol/l/180 min, zenith = 2.6 0.5 vs 4.8 0.7 nmol/l, p < 0.05; diabetic patients = 102 14 vs 205 40 nmol/l/180 min, zenith = 1.4 0.4 vs 3.2 0.3 nmol/l, p < 0.01). The glucose threshold for symptoms was also similar (C = autonomic 3.0 0.1 vs 3.0 0.1, neuroglycopenic = 2.8 0.1 vs 2.9 0.1 mmol/l, D = autonomic 3.2 0.1 vs 3.2 0.1, neuroglycopenic 3.1 0.1 vs

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“…Hypoglycaemia symptom scores Patients filled in a standardised hypoglycaemia symptom questionnaire (the Danish modification of the Edinburgh Hypoglycaemia Scale [17,18]) twice during normoglycaemia, hypoglycaemia and recovery. The symptoms were grouped into three symptom categories; autonomic, neuroglycopenic and other hypoglycaemia symptoms.…”

Section: Methodsmentioning

confidence: 99%

Infrared thermographic assessment of changes in skin temperature during hypoglycaemia in patients with type 1 diabetes

et al. 2015

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Aims/hypothesis Hypoglycaemia is associated with reduced skin temperature (Ts). We studied whether infrared thermography can detect Ts changes during hypoglycaemia in patients with type 1 diabetes and how the Ts response differs between patients with normal hypoglycaemia awareness and hypoglycaemia unawareness. Methods Twenty-four patients with type 1 diabetes (ten aware, 14 unaware) were studied during normoglycaemia (5.0-6.0 mmol/l), hypoglycaemia (2.0-2.5 mmol/l) and during recovery from hypoglycaemia (5.0-6.0 mmol/l) using hyperinsulinaemic glucose clamping. During each 1 h phase, Ts was measured twice by infrared thermography imaging in pre-defined areas (nose, glabella and the five left fingertips), symptoms of hypoglycaemia were scored and blood was sampled.Results Ts decreased during hypoglycaemia on the nose and glabella. The highest decrements were recorded on the nose (aware: −2.6°C, unaware: −1.1°C). In aware patients, the differences in temperature were statistically significant on both nose and glabella, whereas there was only a trend in the unaware group. There was a significant difference in hypoglycaemia-induced temperature changes between the groups. Patients in the aware group had higher hypoglycaemia symptom scores and higher adrenaline (epinephrine) levels during hypoglycaemia. Conclusions/interpretation The hypoglycaemia-associated decrement in Ts can be assessed by infrared thermography Diabetologia (2015) 58:1898-1906 DOI 10.1007 Electronic supplementary material The online version of this article (doi:10.1007/s00125-015-3616-6) contains peer-reviewed but unedited supplementary material, which is available to authorised users. and is larger in patients with normal hypoglycaemia awareness compared with unaware patients.

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Symptoms of Acute Insulin-Induced Hypoglycemia in Humans With and Without IDDM: Factor-Analysis Approach

Cited by 175 publications

References 0 publications

Substitution of night-time continuous subcutaneous insulin infusion therapy for bedtime NPH insulin in a multiple injection regimen improves counterregulatory hormonal responses and warning symptoms of hypoglycaemia in IDDM

Substitution of night-time continuous subcutaneous insulin infusion therapy for bedtime NPH insulin in a multiple injection regimen improves counterregulatory hormonal responses and warning symptoms of hypoglycaemia in IDDM

Brain function rescue effect of lactate following hypoglycaemia is not an adaptation process in both normal and Type I diabetic subjects

Infrared thermographic assessment of changes in skin temperature during hypoglycaemia in patients with type 1 diabetes

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