Hypoglycemia
in Type 2 Diabetes
- Hypoglycemia symptoms are common in type 2 diabetes (38% of patients in one study)
- Associated with:
- Increased morbidity and mortality
- Reduced quality of life
- Reduced treatment satisfaction
- Increased barriers to adherence
- More common at A1C < 7%
When
Does Non-Severe Hypoglycemia Occur with Diabetes?
1/5 of all
non-severe hypoglycemia occurs nocturnally
Symptoms
of Hypoglycemia
- Focal
- Blurred or double vision
- Slurred speech
- Paresthesias
- Tinnitus
- Hemiplegia
- Neuroglycopenic Symptoms
Difficulty
thinking
|
Confusion
|
Poor
coordination
|
Headache
|
Hunger*
|
Weakness*
|
Dizziness
|
Faintness
|
Drowsiness
|
Irritability
|
Nightmares
|
Abnormal
or belligerent behavior
|
Somnolence
|
Seizures
|
Coma
|
|
*These
symptoms are sometimes classified as autonomic
Thresholds
in Response to Hypoglycemia in Normal Subjects
Plasma
Glucose
|
Clinical
Response
|
<60
|
diaphoresis,
anxiety, palpitations, hunger, tremor
|
<55
|
early cognitive
dysfunction
|
<50
|
lethargy and
obtundation
|
<30
|
coma
|
<20
|
convulsions,
death
|
Plasma
Glucose
|
Hormonal
Response
|
<80
|
insulin secretion
suppressed
|
<70
|
glucagon and
epinephrine increased
|
<60
|
growth hormone
and cortisol increased
|
Impaired
Counterregulation in Type 1 Diabetes
- Deficient glucagon response to hypoglycemia
- Deficient epinephrine response to hypoglycemia (“HYPOGLYCEMIC UNAWARENESS”)
- Patients with diminished glucagon and epinephrine response have a 25 fold increase in the frequency of severe hypoglycemia
- Sleep further impairs epinephrine response to hypoglycemia
Potential
Complications of Hypoglycemia
Central
Nervous System
- Cognitive Dysfunction
- Intellectual Decline
- Coma
- Brain Damage
- Seizure
- Focal Neurological Lesions (Rare)
- TIA, Stroke
Heart
- Cardiac arrhythmias
- Myocardial ischemia
Eye
- Vitreous Hemorrhage
- Worsening of retinopathy?
Other
- Falls
- Accidents with injury