Hypoglycemia is almost a mandatory experience for people with diabetes. Both high and low blood glucose are abnormalities of glucose metabolism. Sometimes, a single severe hypoglycemia or a cardiovascular event induced by it can offset the benefits of long-term hypoglycemic therapy, so its prevention and treatment must be strengthened. Diabetic hypoglycemia occurs when a diabetic patient's blood glucose is ≤3.9 mmol/L.

 

What are the risk factors for diabetic hypoglycemia?

1. Exogenous factors. Hypoglycemic episodes caused by exogenous factors are related to absolute or relative insulin overdose, which are commonly seen in: ① For patients who routinely inject insulin subcutaneously, hypoglycemia may occur when exogenous insulin is overdosed, when it is used at the wrong time or in the wrong preparation, or when there is a decrease in eating or a failure to eat on time or an increase in activity after insulin injection; ② Overdosage of oral insulin prosecretory agents (common medications are Glimepiride, Rigolenone, Naglinide, etc.) overdose or take drugs without eating; ③ Liver and renal insufficiency; ④ Alcohol consumption.

2. Endogenous factors. Mainly caused by impaired glucose counter-regulation, which is due to: ① hypoglycemia, glucagon and catecholamine secretion response and insulin secretion inhibition, resulting in hypoglycemic episodes; ② repeated episodes of hypoglycemia caused by hypoglycemia-associated autonomic failure, the lower blood glucose level can not activate the sympathetic - adrenal system to release catecholamines, the patient's lack of hypoglycemia alarm symptoms, that is, patients can not perceive hypoglycemia in time or to the hypoglycemic symptoms of the patient. The patient lacks hypoglycemic alarm symptoms, i.e., the patient is unable to perceive hypoglycemia in time or is insensitive to hypoglycemia. This situation is more serious, especially for elderly patients, because the patient can not sense hypoglycemia in time and take appropriate treatment, and when they are found to be comatose, irreversible hypoglycemic brain damage often occurs.

What are the main types of diabetic hypoglycemia?

Due to the specificity of diabetic hypoglycemia, the ADA proposes the following classification: ① Severe hypoglycemia: after the occurrence of hypoglycemia, the patient can not help himself, and needs the assistance of others to regain consciousness. ② Symptomatic hypoglycemia: hypoglycemic symptoms (panic, cold sweat, intense hunger) are typical and obvious, and blood glucose is ≤3.9mmol/L. ③ Asymptomatic hypoglycemia: there are no typical hypoglycemic symptoms, but the blood glucose is ≤3.9mmol/L. ④ Suspected symptomatic hypoglycemia: there are hypoglycemic symptoms, but blood glucose is not tested. ⑤ Relative hypoglycemia: hypoglycemic symptoms, but blood glucose ≥ 3.9mmol/L.

It is worth noting that for some special groups of people, such as long-term diabetic patients, elderly patients, children, etc., hypoglycemic symptoms are often atypical, such as hypoglycemia manifested as mental behavioral changes, nausea, general weakness, seizures, etc., which need to be taken seriously.

 

What are the preventive and therapeutic measures for diabetic hypoglycemia?

(A) Prevention of hypoglycemia

1. Diabetes education. Self-monitoring of blood glucose is an important means of observing changes in blood glucose and preventing severe hypoglycemia. For diabetic patients and their families, it is very important to master early recognition and management of hypoglycemia through diabetes education. Once the symptoms of hypoglycemia should be eaten immediately, if the patient is found to have a change of consciousness or coma should be dealt with immediately and then sent to the hospital for emergency treatment.

2. Additional meals. Meal refilling is one of the effective means to prevent and control hypoglycemia in patients with type 1 diabetes mellitus, but frequent eating can cause weight gain.

3. Setting appropriate individualized blood glucose control goals. Implement flexible individualized blood glucose control program, timely adjustment of drug dosage, not only strict control of blood glucose, but also reduce the incidence of hypoglycemia.

4. Apply insulin and insulin analogs rationally. Fast-acting insulin analogs can be used in the intensive treatment of diabetic patients to make blood glucose smoother, and glycemic (or ditropan) insulin and insulin pump treatment can reduce the incidence of hypoglycemia.

 

(ii) Treatment of hypoglycemia

Most hypoglycemic reactions can be relieved simply by eating glucose or sugary foods such as fruit juices, soft drinks, candies, or meals, but adequate amounts of starchy staple foods are also needed when blood glucose rises.

First aid for severe hypoglycemia includes intravenous push of 50% dextrose, 5% to 10% dextrose intravenous drip maintenance, and intramuscular injection of glucagon.

(Contributed by: Yu Shan, Endocrine)