The Contribution of Medications to Hypoglycemia Unawareness

White, Jr . John R.

doi:10.2337/diaspect.20.2.77

Cited by 14 publications

(14 citation statements)

References 23 publications

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“…Hypoglycemia unawareness (also called 'impaired awareness of hypoglycemia') is defined as the onset of hypoglycemia before the appearance of autonomic warning symptoms, and presents clinically as the patient's inability to perceive hypoglycemic symptoms [13,31,32]. As noted above, when glucagon responses to hypoglycemia become deficient, epinephrine and autonomic warning symptoms develop into the critical defenses for glucose counter-regulation.…”

Section: Definitionmentioning

confidence: 99%

When hypoglycemia is not obvious: Diagnosing and treating under-recognized and undisclosed hypoglycemia

Kenny¹

2014

Primary Care Diabetes

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Hypoglycemia continues to be a significant problem for patients with diabetes. The incidence remains high but patients may also be under-reporting hypoglycemic events for various reasons, including hypoglycemia unawareness and deliberate non-reporting. This restricts the ability of healthcare professionals to manage treatment effectively. The aim of this article is to focus specifically on the issues associated with hypoglycemia unawareness and undisclosed hypoglycemia. The article provides general practice teams with an overview of these problems and, through patient narratives, suggests ways to mitigate them.

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Section: Definitionmentioning

confidence: 99%

When hypoglycemia is not obvious: Diagnosing and treating under-recognized and undisclosed hypoglycemia

Kenny¹

2014

Primary Care Diabetes

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“…However, it is widely accepted that most patients will begin to experience symptoms when their blood glucose level is less than 3.3 mmol/l (60 mg/dL). The symptoms patients commonly experience are listed in Table 1 below and can be manifestations of the response by the autonomic nervous system as well as the brain's response to being deprived of glucose (Cryer et al, 2003, White, 2007. Physiologic responses with escalating hypoglycemia are shown in Table 2.…”

Section: Definition Of Hypoglycemiamentioning

confidence: 99%

“…There are two proposed mechanisms for this hypoglycemic effect in beta blockers. First, there is a blunting of the signs and symptoms of hypoglycemia (White, 2007). The exception to this blunting effect is sweating, an important educational point for all patients (Product Information: Innopran XL, 2010).…”

Section: Beta Blockersmentioning

confidence: 99%

“…This heightened insulin effect increases glucose utilization in the periphery and inhibits lipolysis. Further, there is a diminished physiologic response to hypoglycemia in patient receiving beta blockers, specifically a decrease in glycogenolysis and gluconeogenesis (Pandit et al, 1993& White, 2007. Patients at greatest risk for hypoglycemia with beta blockers include patients with hepatic disease, patients on hemodialysis, neonates, and patients with type 1 diabetes (Product Information: Innopran XL, 2010).…”

Section: Beta Blockersmentioning

confidence: 99%

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Drug-Induced Hypoglycemia

Helms¹,

Kelley²

2011

Hypoglycemia - Causes and Occurrences

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“…O uso de terbutalina, um agonista ß 2 -adrenérgico, foi testado em pessoas com DM1, e teve como resultado melhora das hipoglicemias noturnas, porém à custa de hiperglicemia na manhã seguinte. Entretanto, não há estudos de longo prazo com nenhuma dessas drogas (60,61).…”

Section: Hipoglicemia Em Dm1unclassified

Hipoglicemia como fator complicador no tratamento do diabetes melito tipo 1

Nery

2008

Arq Bras Endocrinol Metab

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RESuMOos portadores de diabetes melito tipo 1 têm, com freqüência, episódios de hipoglicemia durante a insulinoterapia, que, além do desconforto e de proporcionar situações constrangedoras no dia-a-dia, impedem a obtenção do controle glicêmico ideal. Mais ainda, hipoglicemias induzem deficiente mecanismo de contra-regulação em episódio posterior, com diminuição de liberação de adrenalina e dos sintomas de alarme, estabelecendo a síndrome de hipoglicemia associada à insuficiência autonômica. A ocorrência de hipoglicemias durante algumas atividades de risco, em especial a direção veicular, pode resultar acidentes com o paciente e terceiros, além de lesão de propriedade, motivo pelo qual pessoas com diabetes devem ser orientadas quanto aos cuidados na direção de veículos. em geral, a recuperação neurológica é total após a correção de coma hipoglicêmico. no entanto, quando esses episódios são repetitivos, especialmente em crianças, podem ter como conseqüência distúrbios cognitivos definitivos. A reversão de quadros de hipoglicemia sem sinal de alerta é difícil, devendo-se evitar meticulosamente sua ocorrência, adequando o tratamento, os alvos glicêmicos, utilizando a monitoração domiciliar e fazendo treinamento para o reconhecimento precoce de hipoglicemias. Descritores: diabetes do tipo 1; Hipoglicemia; contra-regulação; insuficiência autonômica; distúrbios cognitivos ABStRAct hypoglycemia as a limiting factor in the Management of type 1 Diabetes. type 1 diabetic patients frequently present hypoglycemic episodes during their insulinotherapy, which, besides the discomfort and constrains does not allow the ideal glycemic control. Further, hypoglycemic events lead to the deficiency of the counter-regulation mechanisms in the subsequent episode, with a decrease in the release of epinephrine and the symptoms of warming, with great risk of severe hypoglycemia. the occurrence of hypoglycemia during some risky activities, specially driving, could result in accidents with the patient and /or third parts including property damage, stressing here the need to advise diabetics against having the necessary caution wheli driving. generally the connective recovery is total after correcting a hypoglycemic coma. However when these episodes are repetitive, particularly in children, they could result in definitive cognitive disturbances. Hypoglycemic events without a warning signal (hypoglycemic unawareness) are difficult to reverse, thus it is necessary to prevent their occurrence, adjusting the treatment with glycemic targets, using continuous glucose monitoring at home and teaching them how to have an early recognition of hypoglycemia. Hipoglicemia em DM1Nery copyright © ABE&M todos os direitos reservados do a gliconeogênese. A liberação de adrenalina resulta maior produção hepática de glicose e diminuição de captação nos tecidos insulino-sensíveis, além de ajudar na percepção dos sintomas e contribuir para diminuição de secreção de insulina por mecanismo α-adrenérgico. Seu papel torna-se crítico quando a secreção de glucagon é in...

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The Contribution of Medications to Hypoglycemia Unawareness

Cited by 14 publications

References 23 publications

When hypoglycemia is not obvious: Diagnosing and treating under-recognized and undisclosed hypoglycemia

When hypoglycemia is not obvious: Diagnosing and treating under-recognized and undisclosed hypoglycemia

Drug-Induced Hypoglycemia

Hipoglicemia como fator complicador no tratamento do diabetes melito tipo 1

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