Korean J Intern Med.  2015 Jan;30(1):6-16. 10.3904/kjim.2015.30.1.6.

Avoiding or coping with severe hypoglycemia in patients with type 2 diabetes

• Yun JS
• Ko SH

• KMID: 2129656
• DOI: http://doi.org/10.3904/kjim.2015.30.1.6

Abstract

Hypoglycemia is a major barrier to achieving the glycemic goal in patients with type 2 diabetes. In particular, severe hypoglycemia, which is defined as an event that requires the assistance of another person to actively administer carbohydrates, glucagon, or take other corrective actions, is a serious clinical concern in patients with diabetes. If severe hypoglycemia is not managed promptly, it can be life threatening. Hypoglycemia-associated autonomic failure (HAAF) is the main pathogenic mechanism behind severe hypoglycemia. Defective glucose counter-regulation (altered insulin secretion, glucagon secretion, and an attenuated increase in epinephrine during hypoglycemia) and a lack of awareness regarding hypoglycemia (attenuated sympathoadrenal activity) are common components of HAAF in patients with diabetes. There is considerable evidence that hypoglycemia is an independent risk factor for cardiovascular disease. In addition, hypoglycemia has a significant influence on the quality of life of patients with diabetes. To prevent hypoglycemic events, the setting of glycemic goals should be individualized, particularly in elderly individuals or patients with complicated or advanced type 2 diabetes. Patients at high-risk for the future development of severe hypoglycemia should be selected carefully, and intensive education with reinforcement should be implemented.

Keyword

Type 2 diabetes; Severe hypoglycemia; Hypoglycemia unawareness; Hypoglycemia-associated autonomic failure; Diabetes education

MeSH Terms

Autonomic Nervous System/physiopathology
Biological Markers/blood
Blood Glucose/*drug effects/metabolism
Diabetes Mellitus, Type 2/blood/complications/diagnosis/*drug therapy/physiopathology
Health Knowledge, Attitudes, Practice
Humans
Hypoglycemia/blood/chemically induced/epidemiology/physiopathology/*prevention & control
Hypoglycemic Agents/*adverse effects
Incidence
Patient Education as Topic
Prevalence
Prognosis
Risk Assessment
Risk Factors
Biological Markers
Blood Glucose
Hypoglycemic Agents