Appreciating, predicting, and preventing hypoglycaemia

Abstract

Summary Hypoglycaemia is a common and feared side-effect of insulin therapy. To avoid severe hypoglycaemia, an individual must recognise the warning symptoms at an early stage and take steps to correct falling blood glucose levels through appropriate self-treatment. The symptoms of hypoglycaemia are age-group specific and change with duration of diabetes. Unfortunately, awareness of hypoglycaemia is impaired in approximately 25% of adults with type 1 diabetes. Although associated with increasing duration of diabetes, this acquired syndrome can occur in people with strict glycaemic control when HbA1c is lowered towards the non-diabetic range. Recurrent exposure to a low blood glucose level modifies the glycaemic thresholds at which neuroendocrine and symptomatic responses are initiated. Other important risk factors for severe hypoglycaemia include sleep, ACE genotype, age, and duration of diabetes. The introduction of insulin analogues and new insulin regimens have helped to limit the frequency of severe hypoglycaemia, particularly at night. Behavioural training, such as the Blood Glucose Awareness Training programme, also can decrease the occurrence of severe hypoglycaemia. The ability to predict and anticipate the risk of developing hypoglycaemia in different situations (such as during physical activity and driving) and increased perception of the early onset of hypoglycaemia, assisted by frequent blood glucose monitoring, may help people with insulin-treated diabetes to avoid severe hypoglycaemia.