Skip to main content
Top
Published in: Diabetes Therapy 6/2017

Open Access 01-12-2017 | Practical Approach

Practical Approaches to Diagnosing, Treating and Preventing Hypoglycemia in Diabetes

Authors: Kathryn Evans Kreider, Katherine Pereira, Blanca I. Padilla

Published in: Diabetes Therapy | Issue 6/2017

Login to get access

Abstract

Hypoglycemia in individuals with diabetes can increase the risk of morbidity and all-cause mortality in this patient group, particularly in the context of cardiovascular impairment, and can significantly decrease the quality of life. Hypoglycemia can present one of the most difficult aspects of diabetes management from both a patient and healthcare provider perspective. Strategies used to reduce the risk of hypoglycemia include individualizing glucose targets, selecting the appropriate medication, modifying diet and lifestyle and applying diabetes technology. Using a patient-centered care approach, the provider should work in partnership with the patient and family to prevent hypoglycemia through evidence-based management of the disease and appropriate education.
Literature
1.
go back to reference Cryer P. Hypoglycemia in diabetes: pathophysiology, prevalence, and prevention. American Diabetes Association:Alexandria, VA. 2012. Cryer P. Hypoglycemia in diabetes: pathophysiology, prevalence, and prevention. American Diabetes Association:Alexandria, VA. 2012.
2.
go back to reference International Hypoglycaemia Study Group. Minimizing hypoglycemia in diabetes. Diabetes Care. 2015;38(8):1583–91.CrossRef International Hypoglycaemia Study Group. Minimizing hypoglycemia in diabetes. Diabetes Care. 2015;38(8):1583–91.CrossRef
3.
go back to reference Lee AK, Warren B, Lee CJ, Huang ES, Sharrett AR, Coresh J, Selvin E. Association of severe hypoglycemia with cardiovascular disease and all-cause mortality in older adults with diabetes: the atherosclerosis risk in communities (ARIC) study. Circulation. 2017;135:A43. Lee AK, Warren B, Lee CJ, Huang ES, Sharrett AR, Coresh J, Selvin E. Association of severe hypoglycemia with cardiovascular disease and all-cause mortality in older adults with diabetes: the atherosclerosis risk in communities (ARIC) study. Circulation. 2017;135:A43.
4.
go back to reference DCCT Research Group. Epidemiology of severe hypoglycemia in the diabetes control and complications trial. Am J Med. 1991;90(4):450–9.CrossRef DCCT Research Group. Epidemiology of severe hypoglycemia in the diabetes control and complications trial. Am J Med. 1991;90(4):450–9.CrossRef
5.
go back to reference UK Hypoglycaemia Study Group. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia. 2007;50(6):1140–7.CrossRef UK Hypoglycaemia Study Group. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia. 2007;50(6):1140–7.CrossRef
6.
go back to reference Pathak RD, Schroeder EB, Seaquist ER, Zeng C, Lafata JE, Thomas A, Karter AJ. Severe hypoglycemia requiring medical intervention in a large cohort of adults with diabetes receiving care in US integrated health care delivery systems: 2005–2011. Diabetes Care. 2016;39(3):363–70.CrossRefPubMed Pathak RD, Schroeder EB, Seaquist ER, Zeng C, Lafata JE, Thomas A, Karter AJ. Severe hypoglycemia requiring medical intervention in a large cohort of adults with diabetes receiving care in US integrated health care delivery systems: 2005–2011. Diabetes Care. 2016;39(3):363–70.CrossRefPubMed
7.
go back to reference Abraira C, Colwell JA, Nuttall FQ, Sawin CT, Nagel NJ, Comstock JP, VA CSDM Group. Veterans Affairs Cooperative Study on glycemic control and complications in type II diabetes (VA CSDM): results of the feasibility trial. Diabetes Care. 1995;18(8):1113–23.CrossRefPubMed Abraira C, Colwell JA, Nuttall FQ, Sawin CT, Nagel NJ, Comstock JP, VA CSDM Group. Veterans Affairs Cooperative Study on glycemic control and complications in type II diabetes (VA CSDM): results of the feasibility trial. Diabetes Care. 1995;18(8):1113–23.CrossRefPubMed
8.
go back to reference Alexiu C, Kirkland SW, Jelinski S, Chuck A, Campbell S, Rowe BH. P112: cost of hypoglycemia associated with diabetes mellitus: a systematic review of the literature. CJEM. 2016;18(S1):S115. Alexiu C, Kirkland SW, Jelinski S, Chuck A, Campbell S, Rowe BH. P112: cost of hypoglycemia associated with diabetes mellitus: a systematic review of the literature. CJEM. 2016;18(S1):S115.
9.
go back to reference Foos V, Varol N, Curtis BH, Boye KS, Grant D, Palmer JL, McEwan P. Economic impact of severe and non-severe hypoglycemia in patients with type 1 and type 2 diabetes in the United States. J Med Econ. 2015;18(6):420–32.CrossRefPubMed Foos V, Varol N, Curtis BH, Boye KS, Grant D, Palmer JL, McEwan P. Economic impact of severe and non-severe hypoglycemia in patients with type 1 and type 2 diabetes in the United States. J Med Econ. 2015;18(6):420–32.CrossRefPubMed
10.
go back to reference Marrett E, Radican L, Davies MJ, Zhang Q. Assessment of severity and frequency of self-reported hypoglycemia on quality of life in patients with type 2 diabetes treated with oral antihyperglycemic agents: a survey study. BMC Res Notes. 2011;4(1):251.CrossRefPubMedPubMedCentral Marrett E, Radican L, Davies MJ, Zhang Q. Assessment of severity and frequency of self-reported hypoglycemia on quality of life in patients with type 2 diabetes treated with oral antihyperglycemic agents: a survey study. BMC Res Notes. 2011;4(1):251.CrossRefPubMedPubMedCentral
11.
go back to reference McCoy R, Van Houten H, Ziegenfuss J, Shah N, Wermers R, Smith S. Self-report of hypoglycemia and health-related quality of life in patients with type 1 and type 2 diabetes. Endocr Pract. 2013;19(5):792–9.CrossRefPubMed McCoy R, Van Houten H, Ziegenfuss J, Shah N, Wermers R, Smith S. Self-report of hypoglycemia and health-related quality of life in patients with type 1 and type 2 diabetes. Endocr Pract. 2013;19(5):792–9.CrossRefPubMed
12.
go back to reference McGill DE, Levitsky LL. Management of hypoglycemia in children and adolescents with type 1 diabetes mellitus. Curr Diabetes Rep. 2016;16(9):88.CrossRef McGill DE, Levitsky LL. Management of hypoglycemia in children and adolescents with type 1 diabetes mellitus. Curr Diabetes Rep. 2016;16(9):88.CrossRef
13.
go back to reference Khunti K, Davies M, Majeed A, Thorsted BL, Wolden ML, Paul SK. Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study. Diabetes Care. 2015;38(2):316–22.CrossRefPubMed Khunti K, Davies M, Majeed A, Thorsted BL, Wolden ML, Paul SK. Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study. Diabetes Care. 2015;38(2):316–22.CrossRefPubMed
15.
go back to reference Bonds DE, Miller ME, Bergenstal RM, et al. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ. 2010;340:b4909.CrossRefPubMedPubMedCentral Bonds DE, Miller ME, Bergenstal RM, et al. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ. 2010;340:b4909.CrossRefPubMedPubMedCentral
16.
go back to reference Skrivarhaug T, Bangstad HJ, Stene LC, Sandvik L, Hanssen KF, Joner G. Longterm mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway. Diabetologia. 2006;49:298–305.CrossRefPubMed Skrivarhaug T, Bangstad HJ, Stene LC, Sandvik L, Hanssen KF, Joner G. Longterm mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway. Diabetologia. 2006;49:298–305.CrossRefPubMed
17.
go back to reference Kreider KE, Padilla BI, Pereira K. Hypoglycemia in diabetes: challenges and opportunities in care. J Nurse Pract. 2017;13(3):228–34.CrossRef Kreider KE, Padilla BI, Pereira K. Hypoglycemia in diabetes: challenges and opportunities in care. J Nurse Pract. 2017;13(3):228–34.CrossRef
19.
go back to reference Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and The Endocrine Society. Diabetes Care. 2013;36(5):1384–95.CrossRefPubMedPubMedCentral Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and The Endocrine Society. Diabetes Care. 2013;36(5):1384–95.CrossRefPubMedPubMedCentral
20.
go back to reference Reno CM, Litvin M, Clark AL, Fisher SJ. Defective counterregulation and hypoglycemia unawareness in diabetes: mechanisms and emerging treatments. Endocrinol Metab Clin North Am. 2013;42(1):15.CrossRefPubMed Reno CM, Litvin M, Clark AL, Fisher SJ. Defective counterregulation and hypoglycemia unawareness in diabetes: mechanisms and emerging treatments. Endocrinol Metab Clin North Am. 2013;42(1):15.CrossRefPubMed
22.
go back to reference Cryer PE. Mechanisms of hypoglycemia-associated autonomic failure in diabetes. N Engl J Med. 2013;369(4):362–72.CrossRefPubMed Cryer PE. Mechanisms of hypoglycemia-associated autonomic failure in diabetes. N Engl J Med. 2013;369(4):362–72.CrossRefPubMed
23.
go back to reference Marso SP, McGuire DK, Zinman B, Poulter NR, Emerson SS, Pieber TR, Moses A. Efficacy and safety of degludec versus glargine in type 2 diabetes. N Engl J Med. 2017; 377:723–32. Marso SP, McGuire DK, Zinman B, Poulter NR, Emerson SS, Pieber TR, Moses A. Efficacy and safety of degludec versus glargine in type 2 diabetes. N Engl J Med. 2017; 377:723–32.
24.
go back to reference Snyder RW, Berns JS. Reviews: use of insulin and oral hypoglycemic medications in patients with diabetes mellitus and advanced kidney disease. Semin Dial. 2004; 17(5):365–70. Snyder RW, Berns JS. Reviews: use of insulin and oral hypoglycemic medications in patients with diabetes mellitus and advanced kidney disease. Semin Dial. 2004; 17(5):365–70.
25.
go back to reference Tsujimoto T, Sugiyama T, Shapiro MF, Noda M, Kajio H. Risk of cardiovascular events in patients with diabetes mellitus on B-blockers. Hypertension. 2017;70:103–10.CrossRefPubMed Tsujimoto T, Sugiyama T, Shapiro MF, Noda M, Kajio H. Risk of cardiovascular events in patients with diabetes mellitus on B-blockers. Hypertension. 2017;70:103–10.CrossRefPubMed
26.
go back to reference Murad MH, Coto-Yglesias F, Wang AT, et al. Drug-induced hypoglycemia: a systematic review. J Clin Endocrinol Metab. 2009;94(3):741–5.CrossRefPubMed Murad MH, Coto-Yglesias F, Wang AT, et al. Drug-induced hypoglycemia: a systematic review. J Clin Endocrinol Metab. 2009;94(3):741–5.CrossRefPubMed
28.
go back to reference Donner T. Insulin—pharmacology, therapeutic regimens and principles of intensive insulin therapy. 2015. In: De Groot LJ, Chrousos G, Dungan K, et al., editors. South Dartmouth (MA): MDText.com, Inc.; 2000. Donner T. Insulin—pharmacology, therapeutic regimens and principles of intensive insulin therapy. 2015. In: De Groot LJ, Chrousos G, Dungan K, et al., editors. South Dartmouth (MA): MDText.com, Inc.; 2000.
29.
go back to reference Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38(1):140–9.CrossRefPubMed Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38(1):140–9.CrossRefPubMed
30.
go back to reference Rodbard D. Continuous glucose monitoring: a review of successes, challenges, and opportunities. Diabetes Technol Ther. 2016;18[Suppl 2]:S2-3–13.CrossRef Rodbard D. Continuous glucose monitoring: a review of successes, challenges, and opportunities. Diabetes Technol Ther. 2016;18[Suppl 2]:S2-3–13.CrossRef
33.
go back to reference Garg SK, Weinzimer SA, Tamborlane WV, Buckingham BA, Bode BW, Bailey TS, Bergenstal RM. Glucose outcomes with the in-home use of a hybrid closed-loop insulin delivery system in adolescents and adults with type 1 diabetes. Diabetes Technol Ther. 2017;19(3):155–63.CrossRefPubMedPubMedCentral Garg SK, Weinzimer SA, Tamborlane WV, Buckingham BA, Bode BW, Bailey TS, Bergenstal RM. Glucose outcomes with the in-home use of a hybrid closed-loop insulin delivery system in adolescents and adults with type 1 diabetes. Diabetes Technol Ther. 2017;19(3):155–63.CrossRefPubMedPubMedCentral
34.
go back to reference Ranjan A, Schmidt S, Madsbad S, Holst JJ, Nørgaard K. Effects of subcutaneous, low-dose glucagon on insulin-induced mild hypoglycaemia in patients with insulin pump treated type 1 diabetes. Diabetes Obes Metab. 2016;18(4):410–8.CrossRefPubMed Ranjan A, Schmidt S, Madsbad S, Holst JJ, Nørgaard K. Effects of subcutaneous, low-dose glucagon on insulin-induced mild hypoglycaemia in patients with insulin pump treated type 1 diabetes. Diabetes Obes Metab. 2016;18(4):410–8.CrossRefPubMed
35.
go back to reference Boyle PJ, Zrebiec J. Management of diabetes-related hypoglycemia. South Med J. 2007;100(2):183–94.CrossRefPubMed Boyle PJ, Zrebiec J. Management of diabetes-related hypoglycemia. South Med J. 2007;100(2):183–94.CrossRefPubMed
36.
go back to reference Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Dequist ER, Service FJ. Evaluation and management of adult hypoglycemic disorders: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(3):709–28.CrossRefPubMed Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Dequist ER, Service FJ. Evaluation and management of adult hypoglycemic disorders: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(3):709–28.CrossRefPubMed
37.
go back to reference Horton ES, Shahar J. Exercise for fitness. In: Beaser RS (ed) Joslin’s diabetes deskbook: a guide for primary care providers. 3rd ed. Boston: Joslin Diabetes Center; 2014. p. 155–85. Horton ES, Shahar J. Exercise for fitness. In: Beaser RS (ed) Joslin’s diabetes deskbook: a guide for primary care providers. 3rd ed. Boston: Joslin Diabetes Center; 2014. p. 155–85.
Metadata
Title
Practical Approaches to Diagnosing, Treating and Preventing Hypoglycemia in Diabetes
Authors
Kathryn Evans Kreider
Katherine Pereira
Blanca I. Padilla
Publication date
01-12-2017
Publisher
Springer Healthcare
Published in
Diabetes Therapy / Issue 6/2017
Print ISSN: 1869-6953
Electronic ISSN: 1869-6961
DOI
https://doi.org/10.1007/s13300-017-0325-9

Other articles of this Issue 6/2017

Diabetes Therapy 6/2017 Go to the issue