Severe Hypoglycemia in Diabetic Patients: Frequency, Causes, Prevention

Abstract

Over a 12-mo period, the frequency of severe hypoglycemic episodes was measured in a population of approximately 400 (50% type I) diabetic patients treated with insulin. There were 32 severe insulin reactions in 26 patients, a patient-yr incidence of 8%. The major precipitating causes were patients' errors (nine), and too much insulin or a wrong combination (six). In seven cases no cause could be found. For the group as a whole there was clear evidence of overtreatment as measured by insulin doses (0.89 +/- 0.43 U/kg/day versus 0.65 +/- 0.34 U/kg/day in a convenience group of 100 patients from the same diabetic population [P less than 0.05] ). Furthermore, 6-12 mo after the event the mean insulin dose had decreased from 0.82 +/- 0.25 to 0.69 +/- 0.27 U/kg/day in the subgroup of 20 hypoglycemic patients that could be followed (P less than 0.001). The mean HbAlc levels of the hypoglycemic group and the control group differed significantly (8.1 +/- 1.3% versus 8.7 +/- 1.7%, P less than 0.05). Six to 12 mo after the reaction, the mean HbAlc level in the follow-up subgroup rose from 8.1 +/- 1.3% to 9.1 +/- 1.1% (P less than 0.05). Patients' errors as a cause of the insulin reaction were not only the result of the patients' deficient knowledge but more often of lack of alertness and carelessness. We conclude that it is not possible to prevent all the severe hypoglycemic reactions in diabetic patients. However, besides avoiding overtreatment by the physician, teaching patients to respond more adequately to changing circumstances in daily life or to warning signs could also reduce the incidence of hypoglycemia.

Experience of severe hypoglycaemia may influence both patient's and physician's subsequent treatment policy of insulin-dependent diabetes mellitus

“…Little is actually known, however, of the possible in¯uence of severe hypoglycaemia on physicians' and patients' treatment policy. Furthermore, little data exist concerning long-term glycaemic control after an experience of severe hypoglycaemia [1].…”

The effect of genetically engineered glucagon on glucose recovery after hypoglycaemia in man.

“…Furthermore, 10% of all insulin treated diabetics experience at least one severe hypoglycaemic episode each year (Casparie & Elving 1985;Potter et al, 1982). Routine treatment of insulin-induced hypoglycaemia in accident and emergency rooms includes i.v.…”

The Impact of a Decade of Changing Treatment on Rates of Severe Hypoglycemia in a Population-Based Cohort of Children With Type 1 Diabetes

“…It has been long recognized that it is important to survey type 1 diabetic patients to determine the risk factors for severe hypoglycemia and monitor therapeutic outcomes (3,4). Earlier reports were difficult to interpret because of methodological problems, variations in definitions of hypoglycemic episodes, and retrospective approaches.…”