Skip to main content
Top
Published in: Diabetologia 5/2021

01-05-2021 | Insulins | Review

The consequences of hypoglycaemia

Author: Stephanie A. Amiel

Published in: Diabetologia | Issue 5/2021

Login to get access

Abstract

Hypoglycaemia (blood glucose concentration below the normal range) has been recognised as a complication of insulin treatment from the very first days of the discovery of insulin, and remains a major concern for people with diabetes, their families and healthcare professionals today. Acute hypoglycaemia stimulates a stress response that acts to restore circulating glucose, but plasma glucose concentrations can still fall too low to sustain normal brain function and cardiac rhythm. There are long-term consequences of recurrent hypoglycaemia, which are still not fully understood. This paper reviews our current understanding of the acute and cumulative consequences of hypoglycaemia in insulin-treated diabetes.

Graphical abstract

Appendix
Available only for authorised users
Literature
1.
go back to reference Cooper T, Ainsberg A (2011) Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle. St Martin’s Press, New York City Cooper T, Ainsberg A (2011) Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle. St Martin’s Press, New York City
2.
go back to reference The International Hypoglycaemia Study Group (2017) Glucose concentrations of less than 3.0 mmol/l (54 mg/dl) should be reported in clinical trials: a joint position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 60:3–6. https://doi.org/10.1007/s00125-016-4146-6 The International Hypoglycaemia Study Group (2017) Glucose concentrations of less than 3.0 mmol/l (54 mg/dl) should be reported in clinical trials: a joint position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 60:3–6. https://​doi.​org/​10.​1007/​s00125-016-4146-6
5.
6.
go back to reference Peacey SR, Rostami-Hodjegan A, George E, Tucker GT, Heller SR (1997) The use of tolbutamide-induced hypoglycemia to examine the intraislet role of insulin in mediating glucagon release in normal humans. J Clin Endocrinol Metab 82:1458–1461PubMed Peacey SR, Rostami-Hodjegan A, George E, Tucker GT, Heller SR (1997) The use of tolbutamide-induced hypoglycemia to examine the intraislet role of insulin in mediating glucagon release in normal humans. J Clin Endocrinol Metab 82:1458–1461PubMed
7.
go back to reference Spyer G, Hattersley AT, MacDonald IA, Amiel S, MacLeod KM (2000) Hypoglycaemic counter-regulation at normal blood glucose concentrations in patients with well controlled type-2 diabetes. Lancet 356(9246):1970–1974 Spyer G, Hattersley AT, MacDonald IA, Amiel S, MacLeod KM (2000) Hypoglycaemic counter-regulation at normal blood glucose concentrations in patients with well controlled type-2 diabetes. Lancet 356(9246):1970–1974
25.
go back to reference Lee S, Harris ND, Robinson RT, Yeoh L, Macdonald IA, Heller SR (2003) Effects of adrenaline and potassium on QTc interval and QT dispersion in man. Eur J Clin Investig 3:93–98CrossRef Lee S, Harris ND, Robinson RT, Yeoh L, Macdonald IA, Heller SR (2003) Effects of adrenaline and potassium on QTc interval and QT dispersion in man. Eur J Clin Investig 3:93–98CrossRef
41.
go back to reference Lawton J, Rankin D, Elliott J et al (2014) Experiences, views, and support needs of family members of people with hypoglycemia unawareness: interview study. Diabetes Care 37:109–115CrossRefPubMed Lawton J, Rankin D, Elliott J et al (2014) Experiences, views, and support needs of family members of people with hypoglycemia unawareness: interview study. Diabetes Care 37:109–115CrossRefPubMed
45.
go back to reference Farrell CM, McNeilly AD, Fournier P et al (2020) A randomised controlled study of high intensity exercise as a dishabituating stimulus to improve hypoglycaemia awareness in people with type 1 diabetes: a proof-of-concept study. Diabetologia 63:853–863. https://doi.org/10.1007/s00125-019-05076-5 Farrell CM, McNeilly AD, Fournier P et al (2020) A randomised controlled study of high intensity exercise as a dishabituating stimulus to improve hypoglycaemia awareness in people with type 1 diabetes: a proof-of-concept study. Diabetologia 63:853–863. https://​doi.​org/​10.​1007/​s00125-019-05076-5
46.
go back to reference Smith CB, Choudhary P, Pernet A, Hopkins D, Amiel SA (2009) Hypoglycemia unawareness is associated with reduced adherence to therapeutic decisions in patients with type 1 diabetes: evidence from a clinical audit. Diabetes Care 32:1196–1198CrossRefPubMedPubMedCentral Smith CB, Choudhary P, Pernet A, Hopkins D, Amiel SA (2009) Hypoglycemia unawareness is associated with reduced adherence to therapeutic decisions in patients with type 1 diabetes: evidence from a clinical audit. Diabetes Care 32:1196–1198CrossRefPubMedPubMedCentral
52.
go back to reference de Zoysa N, Rogers H, Stadler M et al (2014) A psychoeducational program to restore hypoglycemia awareness: the DAFNE-HART pilot study. Diabetes Care 37:863–866CrossRefPubMed de Zoysa N, Rogers H, Stadler M et al (2014) A psychoeducational program to restore hypoglycemia awareness: the DAFNE-HART pilot study. Diabetes Care 37:863–866CrossRefPubMed
54.
go back to reference Standl E, Stevens SR, Lokhnygina Y et al (2020) Confirming the Bidirectional Nature of the Association Between Severe Hypoglycemic and Cardiovascular Events in Type 2 Diabetes: Insights From EXSCEL. Diabetes Care 43:1–10CrossRef Standl E, Stevens SR, Lokhnygina Y et al (2020) Confirming the Bidirectional Nature of the Association Between Severe Hypoglycemic and Cardiovascular Events in Type 2 Diabetes: Insights From EXSCEL. Diabetes Care 43:1–10CrossRef
57.
58.
go back to reference Cukierman-Yaffe T, Bosch J, Jung H, Punthakee Z, Gerstein HC (2019) Hypoglycemia and Incident Cognitive Dysfunction: A Post Hoc Analysis From the ORIGIN Trial. Diabetes Care 42:142–147CrossRefPubMed Cukierman-Yaffe T, Bosch J, Jung H, Punthakee Z, Gerstein HC (2019) Hypoglycemia and Incident Cognitive Dysfunction: A Post Hoc Analysis From the ORIGIN Trial. Diabetes Care 42:142–147CrossRefPubMed
Metadata
Title
The consequences of hypoglycaemia
Author
Stephanie A. Amiel
Publication date
01-05-2021
Publisher
Springer Berlin Heidelberg
Published in
Diabetologia / Issue 5/2021
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-020-05366-3

Other articles of this Issue 5/2021

Diabetologia 5/2021 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine