Hypoglycemia is common problem seen in diabetic patients on insulin. It is due to imbalance between insulin requirement and administration. Highest risk is just before meals and during night. All patients on insulin and oral hypoglycemic agents should be aware of the causes of hypoglycemia and try to avoid them.
Causes of hypoglycemia in diabetes
Relative or absolute insulin excess.
Increased dose of insulin or insulin secretagogue (agents that help to increase insulin secretion) such as sulfonylureas and meglitinides which stimulate insulin secretion.
Intake of glucose is reduced.
- Missed or delayed meals.
- Insufficient carbohydrate in meals.
Increased glucose utilization.
- Vigorous exercises.
Increased sensitivity to insulin.
- With improved glycemic control, late after exercise, in the middle of the night, weight loss. All this situation causes increased sensitivity to insulin.
Deceased glucose production.
- Alcohol intake.
Reduced clearance of insulin.
Renal failure.
Poorly decoded insulin regimen.
Lipohypertrohy at injection sites - Erratic insulin absorption from areas of fat
Gastroparesis
Malabsorption diseases
Risk factors of hypoglycemia in diabetic patients
- Impaired awareness of hypoglycemia-Patient fail to recognize the clinical features of hypoglycemia.
- Strict glycemic control.
- Extremes of age group.
- Long duration of dm.
- Type 2 DM treated with sulfonylureas, insulin.
- Somogyi phenomenon.
Early morning hypoglycemia (at 3 am) followed by hyperglycemia resulting in elevated fasting blood glucose. This phenomenon is due to increased night dose of insulin.
Management of hypoglycemia
- Primary prevention
- Patient education
- Frequent self monitoring
- Use flexible drug regimens
- Professional guidance
