Hypoglycemia

Hypoglycemia is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Classification

Hypoglycemia is uncommon in patients not treated for diabetes. Iatrogenic factors usually account for hypoglycemia in the setting of diabetes, whereas hypoglycemia in the population without diabetes could be classified as fasting or postprandial hypoglycemia. Iatrogenic hypoglycemia complicates therapy with insulin or SFUs and is a limiting factor to achieving glycemic control during intensive therapy in patients with diabetes.1

Risk Factors

Hypoglycemia resulting from too intensive diabetes management may increase the risk of mortality in older patients with a long duration of diabetes and should be avoided.

  • Risk factors for iatrogenic hypoglycemia include skipped or insufficient meals, unaccustomed physical exertion, misguided therapy, alcohol ingestion, and drug overdose.
  • Recurrent episodes of hypoglycemia impair recognition of hypoglycemic symptoms, thereby increasing the risk for severe hypoglycemia (hypoglycemia unawareness).
  • Hypoglycemia unawareness results from defective glucose counterregulation with blunting of autonomic symptoms and counterregulatory hormone secretion during hypoglycemia. Seizures or coma may develop in such patients without the usual warning symptoms of hypoglycemia.
  • Hypoglycemia unrelated to diabetes therapy is an infrequent problem in general medical practice.

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