In recent years the interest of the scientific community has turned to a complication of diabetes, hypoglycemia.
If diabetes is the metabolic scourge of our time, Hypoglycemia is its most life-threatening complication. It is an acute condition that must be treated by the patient himself and the people close to him during its onset. Therefore, the good information, this life-saving "medicine" in all emergencies does not only concern the sufferers but literally each of us, since it can help us help life go on, reports Aikaterini N.. Τρικκαλινού, MD, PHD C,Pathologist - Diabetologist, Curator of Diabetology – Metropolitan Hospital Cardiometabolic Center.
Hypoglycemia is an acute complication of diabetes. In recent years, the scientific interest has become more and more focused on her, as our knowledge in this area increases and its short-term and long-term consequences are recognized. It is now clear that patients with hypoglycaemic events are at greater risk than those who do not.. In this group and compared to the rest of the affected population, the risk of having a heart attack, heart attack or stroke, or death (MACE) eight times one week after an episode of severe hypoglycaemia and remains double for more than a year after the event, as shown by the analysis of the LEADER study. also, from the same study, we know that the risk of mortality from all causes increases tenfold after a severe hypoglycemic event and remains doubled for more than a year after the event. Unfortunately, there are many cases of hypoglycemia in the elderly and young people even today, although new insulin biotechnology and new antidiabetic tablets have significantly reduced the incidence of hypoglycemia..
What is hypoglycemia?
According to the guidelines of the Hellenic Diabetes Society (2018) Hypoglycaemia is defined as a condition in which plasma glucose is less than 70 mg / dl with or without symptoms..
Causes of hypoglycemia
• Late meal intake
• Skipping a meal
• Reduced amount of meal
• Slimming diet
• Neurogenic anorexia
• Unusual physical fatigue
• Alcohol intake
• Inadequate doses and type of insulin
• Very strict diabetes management
• Endocrine deficiencies
• Reduced glucose counteraction
• Decreased perception of hypoglycemia
Discontinuation of corticosteroids
• Renal failure
• Gastroparesis, vomiting
• Absorption syndrome
• Decreased perception of doctor instructions.
Symptoms of hypoglycemia
A) Adrenergic (due to stimulation of the autonomic nervous system): sweating, anxiety, cervical hemorrhages, nausea feeling of heat, tachycardia, palpitations and trembling movements.
B) Neuroglycopenic (due to reduced supply of glucose to the brain): headache, decrease in concentration, dysarthria, behavioral disorder, confusion, drowsiness, lethargy, shudder, transient hemiplegia, aphasia, convulsions, coma.
Symptoms of hypoglycemia
Symptoms of hypoglycemia
C) Not special ̶ unclassified: hunger, weakness, diplopia, blurred vision.
It is extremely important to note that the symptoms of hypoglycemia vary with age. Behavior change predominates in childhood, in middle age the symptoms described above appear, while in old age the neurological symptoms that often make diagnosis difficult predominate (vision disorders, balance disorders, lack of movement coordination). also, the perception of the symptoms of hypoglycemia may be affected, be prevented or modified by a number of factors such as: the sleep, the distraction (for example during the patient's work), body position, medicines, alcohol, psychological factors, or ignorance of the symptoms of hypoglycemia. End, It is very important to mention that the symptoms of hypoglycemia vary not only from person to person but also from hypoglycemic episode to hypoglycemic episode and, of course, change over time and the duration of diabetes and recurrent episodes of hypoglycaemia.
Categories of hypoglycemia
Mild-mild hypoglycemia: gives mild symptoms of hypoglycemia which may be sweating tachycardia and a feeling of fatigue and may distract the patient.
Clinically significant hypoglycemia: is defined as the condition in which the plasma glucose is lower than 54 mg / dl.
Severe hypoglycemia: this is hypoglycemia (regardless of glucose level) in which the patient needs help from others to correct it and gain full contact with the environment. also, according to other authors, The use of the terms clinical hypoglycemia is important, when there are symptoms and signs of hypoglycaemia that are elevated by glucose administration, biochemical hypoglycaemia when plasma glucose levels are below 70 mg / dl (or other authors below 58mg / dl or below 50mg / dl if venous blood). In the latter category of hypoglycemia, in 40% of patients there are no subjective symptoms of hypoglycemia, that is,, these patients have a pathologically reduced perception of hypoglycaemia. We are talking about unconscious hypoglycemia or lack of awareness of hypoglycemia, when patients either do not realize hypoglycemia or, when they show symptoms, they already have neuroglycopenia and therefore do not realize it. This concerns 20%-25% of patients with insulin-dependent type 2 diabetes 1 and 10% of patients with non-insulin dependent type diabetes 2 in whom the risk of severe hypoglycaemia is sixfold. Is, also, It is important to note that unconscious hypoglycaemia is treated and reversed with appropriate patient education to reduce hypoglycaemic episodes and improve the perception of hypoglycaemia symptoms.. End, special mention should be made of nocturnal hypoglycemia, as patients overnight do not perform normal self-monitoring and are not alert, and the symptoms may not be understood. These can be restless sleep, nightmares, morning headache, feeling tired when waking up, unexplained drowsiness, sweat underwear.
In non-diabetic individuals
The decrease in glucose levels in normal individuals has the following consequences (perfectly matched to the specific plasma glucose levels).
1. Reduction of insulin secretion by β cells (glucose 80mg / dl).
2. Increase in glucagon and adrenaline (glucose 69mg / dl).
3. Increase in cortisol and growth hormone as well as other neurotransmitters (glucose 67mg / dl).
4. Occurrence of neurogenic-adrenergic symptoms (glucose55mg / dl).
5. Occurrence of neuroglycopenic symptoms (glucose 50mg / dl).
6. Disorders of mental functions (glucose 46 mg/dl).
In diabetic individuals
The above-mentioned compensatory mechanisms are disturbed in people with diabetes. Thus in "unregulated" patients (with unregulated diabetes) glucose levels move to higher values, while in strictly "regulated" patients it is possible to move to lower values.
The immediate risks of hypoglycemia
Hypoglycemia has many immediate consequences. Thymic disorders, depression, convulsions, coma, reduced working performance, dangerous driving behavior, car accidents, falls to the ground, fractures, injuries, acute events (cardiac ischemia, Stroke, heart attack, arrhythmias, opposition death).
The long-term risks of hypoglycemia
Long term, Frequent hypoglycemia can cause problems in patients' working lives (dismissal, unemployment), difficulty obtaining or losing a driver's license, reduced quality of life, disorders in interpersonal relationships, fear, deficient compliance in the treatment of diabetes, cognitive impairment, dementia, disadvantageous compensation of hypoglycemia, unconscious hypoglycemia.
Treatment of hypoglycemia
Hypoglycaemia should be treated immediately, because the patient's life is in danger. If possible, blood sugar should be measured to confirm hypoglycaemia. If it is not possible or there is no other person to help, the patient should take glucose immediately., e.g., half a glass of fruit juice, or three glucose pills or a pack of glucose jelly or 5-6 hard candies. After 15 minutes glucose re-monitoring should be performed. If the sugar levels are still low, repeat the intake of sugary liquid followed by a regular meal or snack. (caution: preparations taken to correct hypoglycemia should not be liquid, jellies or candies without sugar). The other sweets, for example chocolate, the croissants, cookies due to their high fat content (fat slows down the release of glucose from the gut into the bloodstream) are unsuitable for the immediate treatment of hypoglycemia.
Measures to prevent hypoglycemia
1. Frequent meals: six meals a day tailored to patients' needs. Breakfast, decimal, lunch afternoon, dinner and bedtime meal (Its importance in the prevention of nocturnal hypoglycemia).
2. Avoid delayed meals (especially when insulin mixtures are used).
3. Rational self-control, with blood sugar measurements. Especially if, before bed, blood glucose is lower than 110 mg / dl then a carbohydrate meal is required.
4. Avoid physical exhaustion or extreme fatigue.
5. Regular control of comorbidities.
Which of the above is required for the patient to know when leaving the diabetes clinic;
The patient who was diagnosed with diabetes, especially type 2 diabetes 1, must, definitely, along with the diagnosis, to be informed and, if possible, to get acquainted (to know as much as he can face) the following:
• What is hypoglycemia
• What are the limits of hypoglycemia?
• What are the symptoms of hypoglycemia?
• What to do if you have hypoglycemia
• How to prevent future hypoglycemia.