Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2014

Hypoglycemia Update (#159)

Tim Jones 1
  1. Princess Margaret Hospital, Perth, WA, Australia

Hypoglycemia is common in the treatment of both Type 1 and Type 2 diabetes and is one of the most frequent acute complications of the treatment of diabetes with insulin and sulfonylureas.   The risk of recurrent and severe hypoglycemia causes significant anxiety and emotional morbidity for patients and families and is a limiting factor in achieving tight glycemic control.  Hypoglycemia can have a range of adverse consequences including unpleasant or embarrassing and potentially dangerous symptoms, impaired concentration and behavioral disturbances.  The morbidity from hypoglycemia may involve cardiovascular and central nervous systems. Severe, prolonged hypoglycemia, in particular during sleep, can result in coma, seizures and even death. 

In Type 1 Diabetes, hypoglycemia results from imperfect insulin replacement combined with counterregulatory hormone defects. The development of hypoglycemia associated autonomic failure and impaired hypoglycemia awareness places a patient at particular risk. It is important that hypoglycemia is recognized as a key component of diabetes care and that patients and families receive education about its causes, effects, treatment and prevention. At the same time, patients need reassurance that good glycemic control can be achieved without frequent severe hypoglycemic events since fear of hypoglycemia is common and disabling for many caregivers and young people with diabetes. .  Rates of severe hypoglycemia should be monitored as an important outcome of clinical management. The development of impaired hypoglycemia unawareness should be managed aggressively.

In recent years, there have been improvements in insulin therapy, including availability of insulin analogues and insulin pump therapy.  The introduction of continuous glucose monitoring systems offers additional insight and opportunity to improve diabetes control.  Although there are some data to suggest that severe hypoglycemia has reduced in incidence recently, hypoglycemia remains common. 

Furthermore, despite advances in therapy, the majority of patients fail to achieve recommended glycemic targets in part because of the risk of hypoglycemic events and as a result do not enjoy the benefits of optimal glycemic control.