Hypoglycaemia unawareness in patients with type 1 diabetes

Abstract

Hypoglycaemia unawareness, defined at the onset of neuroglycopenia before the appearance of autonomic warning symptoms, is a serious problem in type 1 diabetes mellitus. It is often caused by recurrent or severe hypoglycaemia, which leads to the failure of the autonomic nervous system (hypoglycaemia-associated autonomic failure -HAAF). The hypoglycaemia awareness can be restored by avoiding episodes of hypoglycaemia. Management of hypoglycaemia unawareness is complex, and can only be achieved by a multifactorial intervention of clinical care and structured patient education. In patients in whom functional intensive insulin therapy with insulin analogue, continuous subcutaneous insulin infusion using insulin pumps are ineffective in the prevention of hypoglycaemia the implementation of continuous glucose monitoring (CGM) is advisable. CGM systems equipped with low glucose alarms and prediction alarms not only significantly reduce the risk of severe hypoglycaemia, but also significantly reduce the fear of hypoglycaemia and improve the quality of life of patients and their families. The insulin pumps integrated with CGM automatically suspending insulin infusion when glucose is predicted to soon be low (PLGS) should be preferred in patient with hypoglycaemia unawareness. Hypoglycaemia management is complex and should also include structural education. Particular attention should be paid to the management of hypoglycaemia and appropriate use of modern therapy. The hypoglycaemia unawareness is very common among children under the age of 6 years who are unable to observe the early symptoms of hypoglycaemia by themselves. This induces a high risk of frequent and severe hypoglycaemia, which can lead to structural changes in the brain, cognitive dysfunctions, poor mental abilities and behavioral disorders later in life. Słowa kluczowe: type 1 diabetes, hypoglycaemia unawareness, continuous glucose monitoring, insulin pump. StreszczenieNieświadomość hipoglikemii, definiowana jako brak możliwości rozpoznania objawów hipoglikemii przez pacjenta, stanowi istotny problem kliniczny wśród chorych na cukrzycę typu 1. Najczęściej jest spowodowana nawracającymi niedocukrzeniami, które prowadzą do wystąpienia niewydolności autonomicznego układu nerwowego związanej z hipoglikemią (hypoglycaemia-associated autonomic failure -HAAF). Unikanie hipoglikemii może przywrócić zdolność do jej odczuwania. U pacjentów, u których zastosowanie funkcjonalnej intensywnej insulinoterapii z użyciem insulin analogowych oraz ciągłego podskórnego wlewu insuliny za pomocą pomp insulinowych jest nieskuteczne, wskazane jest wdrożenie ciągłego monitorowania glikemii. Systemy ciągłego monitorowania wyposażone w alarmy niskich glikemii i alarmy predykcyjne nie tylko znacznie redukują ryzyko wystąpienia ciężkich hipoglikemii, lecz także istotnie zmniejszają lęk przed hipoglikemią oraz poprawiają jakość życia zarówno pacjentów, jak i ich rodzin. Pompy insulinowe połączone z ciągłym monitorowaniem glikemii (continuous glucose monitoring -CGM), automatycznie wstrz...

The influence of hypoglycemia on the specific quality of life in type 2 diabetes mellitus: a comparative cross-sectional study of diabetics with and without hypoglycemia in Xi’an, China

“…In the realistic scene, when diabetics have hypoglycemia, they will have a sense of near death in serious cases and if they are not treated in a short time, they will cause irreversible brain damage or even death, which scary them severely [36,37]. Most of the time, the occurrence of hypoglycemia is not easy to detect, namely asymptomatic hypoglycemia [38]. Diabetics who have suffered from hypoglycemia will always worry that they will get hypoglycemia again [39].In the future blood glucose management, diabetics dare not make their blood glucose too low, causing a vicious circle of poor management of blood glucose and thus damaging their quality of life [22,40,41].…”

The Influence of Hypoglycemia on the Specific Quality of Life in Type 2 Diabetes Mellitus: a Comparative Cross-sectional Study of Diabetics With and Without Hypoglycemia in Xi'an, China

“…In the realistic scene, when diabetics have hypoglycemia, they will have a sense of near death in serious cases and if they are not treated in a short time, they will cause irreversible brain damage or even death, which scary them severely [34,35]. Most of the time, the occurrence of hypoglycemia is not easy to detect, namely asymptomatic hypoglycemia [36]. Diabetics who have suffered from hypoglycemia will always worry that they will get hypoglycemia again [37].In the future blood glucose management, diabetics dare not make their blood glucose too low, causing a vicious circle of poor management of blood glucose and thus damage their quality of life [20,38,39].…”

Falla autonómica asociada a hipoglucemia

“…La HI es frecuente en los niños menores de 6 años que no detectan los síntomas de hipoglucemia tempranamente por sí mismos, y están expuestos a un elevado riesgo de hipoglucemia frecuente y severa, que puede ocasionar daño estructural cerebral, disfunción cognitiva, incluso menores habilidades mentales y desórdenes conductuales más tarde en la vida 61 .…”