Hypoglycaemia: An overview

Graveling, Alex; Frier, Brian M.

doi:10.1016/j.pcd.2009.08.007

Cited by 71 publications

(53 citation statements)

References 62 publications

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“…Thus, short-term avoidance of hypoglycaemia reverses hypoglycaemia unawareness in most affected patients, an important observation for all diabetes care providers. The clinical approach to minimizing hypoglycaemia while improving glycaemic control includes multiple strategies that are beyond the scope of this review [29,30].…”

Section: Brain a Glucose-dependent Organ Exposed To Hypoglycaemiamentioning

confidence: 99%

“…Hypoglycaemia is a frequent side-effect of treatment with insulin and sulfonylureas for people with DM, threatening potentially serious morbidity and preventing optimal glycaemic control [28,30]. Indeed, fear of hypoglycaemia and development of syndromes such as impaired awareness and counterregulatory deficiency provide additional hazards for intensification of treatment.…”

Section: Brain a Glucose-dependent Organ Exposed To Hypoglycaemiamentioning

confidence: 99%

“…The barrier of hypoglycaemia generally precludes maintenance of euglycaemia over a lifetime of DM and thus precludes full realization of euglycaemia's long-term benefits. Measures to reduce the risk of hypoglycaemia are labourintensive and require substantial resources [29,30].…”

Section: Brain a Glucose-dependent Organ Exposed To Hypoglycaemiamentioning

confidence: 99%

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Central nervous system: a conductor orchestrating metabolic regulations harmed by both hyperglycaemia and hypoglycaemia

Scheen

2010

Diabetes & Metabolism

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SUMMARYRecent evidence suggests a key role for the brain in the control of energy metabolism, body fat content and glucose metabolism. Neuronal systems, which regulate energy intake, energy expenditure, and endogenous glucose production, sense and respond to input from hormonal and nutrient-related signals that convey information regarding both body energy stores and current energy availability. In response to this input, adaptive changes occur that promote energy homeostasis and the maintenance of blood glucose levels in the normal range. Defects in this control system are implicated in the link between obesity and type 2 diabetes mellitus. Central nervous system may be considered as the conductor of an orchestra implicating many peripheral organs involved in these homeostatic processes. However, brain is mainly a glucose-dependent organ, which can be damaged by both hypoglycaemia and hyperglycaemia. Hypoglycaemia unawareness is a major problem in clinical practice and is associated with an increased risk of coma. Stroke is another acute complication associated with diabetes mellitus, especially in elderly people, and control of glucose level in this emergency situation remains challenging. The prognosis of stroke is worse in diabetic patients and both the prevention management of at risk patients should be improved. Finally, chronic diabetic encephalopathies, which may lead to cognitive dysfunction and even dementia, are also recognized. They may result from recurrent hypoglycaemia and/or from chronic hyperglycaemia leading to cerebral vascular damages. Functional imaging is of interest to explore diabetes-associated cerebral abnormalities. Thus, the intimate relationship between brain and diabetes is increasingly acknowledged in both research and clinical practice. Key-words

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Section: Brain a Glucose-dependent Organ Exposed To Hypoglycaemiamentioning

confidence: 99%

Section: Brain a Glucose-dependent Organ Exposed To Hypoglycaemiamentioning

confidence: 99%

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Central nervous system: a conductor orchestrating metabolic regulations harmed by both hyperglycaemia and hypoglycaemia

Scheen

2010

Diabetes & Metabolism

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“…The intent of this article is not to reiterate that information but, rather, to summarize the relevant background and then focus on pragmatic approaches to minimizing hypoglycemia. Efforts to minimize hypoglycemia include acknowledging the problem, considering each risk factor, and applying the relevant principles of intensive glycemic therapy (3)(4)(5)(6). The principles of intensive glycemic therapy include avoiding sulfonylureas and glinides; using more physiological insulin regimens, such as insulin analogs, when insulin is indicated; ensuring users are confident in their self-management; considering insulin treatment technologies such as continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), and CSII with CGM (ideally with suspension of insulin infusion when glucose levels fall to a selected low value) for selected patients; and closed-loop insulin or insulin and glucagon replacement or pancreas or pancreatic islet transplantation for the few patients in whom hypoglycemia persists.…”

mentioning

confidence: 99%

Minimizing Hypoglycemia in Diabetes

2015

Diabetes Care

162

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Hypoglycemia caused by treatment with a sulfonylurea, a glinide, or insulin coupled with compromised defenses against the resulting falling plasma glucose concentrations is a problem for many people with diabetes. It is often recurrent, causes significant morbidity and occasional mortality, limits maintenance of euglycemia, and impairs physiological and behavioral defenses against subsequent hypoglycemia. Minimizing hypoglycemia includes acknowledging the problem; considering each risk factor; and applying the principles of intensive glycemic therapy, including drug selection and selective application of diabetes treatment technologies. For diabetes health-care providers treating most people with diabetes who are at risk for or are suffering from iatrogenic hypoglycemia, these principles include selecting appropriate individualized glycemic goals and providing structured patient education to reduce the incidence of hypoglycemia. This is typically combined with short-term scrupulous avoidance of hypoglycemia, which often will reverse impaired awareness of hypoglycemia. Clearly, the risk of hypoglycemia is modifiable.Hypoglycemia is the major limiting factor in the glycemic management of diabetes with a sulfonylurea, a glinide, or insulin (1,2). It is often recurrent, causes significant morbidity in most people with type 1 diabetes and in many with advanced type 2 diabetes (i.e., those with absolute endogenous insulin deficiency), and is sometimes fatal. Hypoglycemia limits maintenance of euglycemia over a lifetime of diabetes and, thus, generally prevents full realization of the benefits of glycemic control. It impairs defenses against subsequent falling plasma glucose concentrations and can cause impaired awareness of hypoglycemia, therefore resulting in a vicious cycle of recurrent hypoglycemia.The problem of hypoglycemia in diabetes has been recently reviewed in detail (1,2). The intent of this article is not to reiterate that information but, rather, to summarize the relevant background and then focus on pragmatic approaches to minimizing hypoglycemia. Efforts to minimize hypoglycemia include acknowledging the problem, considering each risk factor, and applying the relevant principles of intensive glycemic therapy (3-6). The principles of intensive glycemic therapy include avoiding sulfonylureas and glinides; using more physiological insulin regimens, such as insulin analogs, when insulin is indicated; ensuring users are confident in their self-management; considering insulin treatment technologies such as continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), and CSII with CGM (ideally with suspension of insulin infusion when glucose levels fall to a selected low value) for selected patients; and closed-loop insulin or insulin and glucagon replacement or pancreas or pancreatic islet transplantation for the few patients in whom hypoglycemia persists. However, for the majority of people with diabetes who are at risk for or are suffering from iatrogenic hypoglycemia, the principle...

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“…Alterações de equilíbrio, coordenação, visão e nível de consciência decorrentes da hipoglicemia podem precipitar quedas e ferimentos [48][49][50] .…”

Section: Etapa 1: Caracterização Do Evento Agudo De Saúdeunclassified

Critérios de decisão para a definição de exames médicos ocupacionais em atividades críticas: proposição de modelo e exemplos de aplicação no trabalho em altura

Hayashide

Buschinelli

2017

Rev. bras. saúde ocup.

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ResumoIntrodução: no Brasil, tem-se observado uma grande disparidade entre os protocolos de exames médicos utilizados para avaliar trabalhadores que exercem atividades críticas. Objetivo: propor e verificar a aplicabilidade de um modelo baseado em critérios para a tomada de decisão na definição de exames médi-cos ocupacionais na avaliação de aptidão de trabalhadores que executam atividades críticas de trabalho. Métodos: ensaio baseado em pesquisa bibliográfica. O modelo proposto baseia-se no princípio As Low As Reasonably Practicable (ALARP), do Health and Safety Executive (HSE). O modelo foi aplicado a duas condições clínicas que podem resultar em eventos agudos de perda de consciência e levar à queda durante o trabalho em altura, caso falhem ou não tenham sido adotadas medidas de segurança: diabetes e epilepsia. Discussão: verificou-se que o modelo proposto se mostrou aplicável para os dois exemplos analisados, oferecendo subsídios para a tomada de decisão do médico do trabalho em relação à necessidade de se investigar condições clínicas que podem ocasionar acidentes fatais durante a realização de atividades críticas de trabalho. Palavras-chave: tomada de decisões; exames médicos; gestão de riscos; saúde do trabalhador; acidentes de trabalho. Abstract

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Hypoglycaemia: An overview

Cited by 71 publications

References 62 publications

Central nervous system: a conductor orchestrating metabolic regulations harmed by both hyperglycaemia and hypoglycaemia

Central nervous system: a conductor orchestrating metabolic regulations harmed by both hyperglycaemia and hypoglycaemia

Minimizing Hypoglycemia in Diabetes

Critérios de decisão para a definição de exames médicos ocupacionais em atividades críticas: proposição de modelo e exemplos de aplicação no trabalho em altura

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