Hypoglycaemia in Clinical Diabetes

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REFERENCES 117CONCLUSIONS• Hypoglycaemia is associated with multiple risk factors.• Alcohol is a frequent cause of severe hypoglycaemia.• Alcohol is associated with delayed hypoglycaemia through impaired hypoglycaemiaawareness and an abnormal counterregulatory response.• Understanding of the nature of alcohol-associated hypoglycaemia is the first step toreducing the risks associated with alcohol.• Caffeine may augment the symptomatic and hormonal responses to hypoglycaemia andreduce nocturnal hypoglycaemia in individuals with type 1 diabetes.• Continuous Glucose Monitoring is a useful adjunct to the management of the patient withtype 1 diabetes.• Treatment of hypoglycaemia can be regarded as a spectrum of increasing therapeuticcomplexity depending on the severity of the hypoglycaemia and the clinical status of thepatient.REFERENCESAvogaro A, Beltramello P, Gnudi L, Maran A, Valerio A, Miola M et al. (1993). Alcohol intakeimpairs glucose counterregulation during acute insulin-induced hypoglycemia in IDDM patients.Evidence for a critical role of free fatty acids. Diabetes 42: 1626–34.Bjork E, Palmer M, Schvarcz E, Berne C (1990). Incidence of severe hypoglycaemia in an unselectedpopulation of patients with insulin-treated diabetes mellitus, with special reference to autonomicneuropathy. Diabetes Nutrition and Metabolism 4: 303–9.Bode B, Gross K, Rikalo N, Schwartz S, Wahl T, Page C et al. (2004). Alarms based on real-timesensor glucose values alert patients to hypo- and hyperglycemia: the guardian continuous monitoringsystem. Diabetes Technology and Therapeutics 6: 105–13.Bott S, Bott U, Berger M, Muhlhauser I (1997). Intensified insulin therapy and the risk of severehypoglycaemia. Diabetologia 40: 926–32.Brown TM, Harvey AM (1941). Spontaneous hypoglycemia in ‘smoke’ drinkers. Journal of theAmerican Medical Association 17: 12–5.Caplin NJ, O’Leary P, Bulsara M, Davis EA, Jones TW (2003). Subcutaneous glucose sensor valuesclosely parallel blood glucose during insulin-induced hypoglycaemia. Diabetic Medicine 20: 238–41.Cheyne EH, Cavan DA, Kerr D (2002). Performance of a continuous glucose monitoring system duringcontrolled hypoglycemia in healthy volunteers. Diabetes Technology and Therapeutics 4: 607–13.Cheyne E, Kerr D (2002). Making ‘sense’ of diabetes: using a continuous glucose sensor in clinicalpractice. Diabetes Metabolism Research and Reviews 18 Suppl 1: S43–8.Cheyne EH, Sherwin RS, Lunt MJ, Cavan DA, Thomas PW, Kerr D (2004). Influence of alcoholon cognitive performance during mild hypoglycaemia; implications for type 1 diabetes. DiabeticMedicine 21: 230–7.Collier A, Steedman DJ, Patrick AW, Nimmo GR, Matthews DM, MacIntyre CA et al. (1987).Comparison of intravenous glucagon and dextrose in treatment of severe hypoglycemia in anAccident and Emergency Department. Diabetes Care 10: 712–5.Conway S, Mauceri H (1991). The influence of acute ethanol exposure on growth hormone release infemale rats. Alcohol 8: 159–64.
118 MODERATORS, MONITORING AND MANAGEMENTCox DJ, Gonder-Frederick L, Julian DM, Clarke W (1994). Long-term follow-up of blood glucoseawareness training. Diabetes Care 17: 1–5.Daneman D, Frank M, Perlman K, Tamm J, Ehrlich R (1989). Severe hypoglycemia in children withinsulin-dependent diabetes mellitus: frequency and predisposing factors. Journal of Pediatrics 115:681–5.Debrah K, Sherwin RS, Murphy J, Kerr D (1996). Effect of caffeine on recognition of and physiologicalresponses to hypoglycaemia in insulin-dependent diabetes. Lancet 347: 19–24.Evans SB, Wilkinson CW, Gronbeck P, Bennett JL, Taborsky GJ Jr, Figlewicz DP (2003). Inactivationof the PVN during hypoglycemia partially simulates hypoglycemia-associated autonomic failure.American Journal of Physiology. 284: R57–65.Fanelli C, Pampanelli S, Epifano L, Rambotti AM, Ciofetta M, Moda F et al. (1994). Relative rolesof insulin and hypoglycaemia on induction of neuroendocrine responses to, symptoms of, anddeterioration of cognitive function in hypoglycaemia in male and female humans. Diabetologia 37:797–807.Feldman M, Schiller LR (1983). Disorders of gastrointestinal motility associated with diabetes mellitus.Annals of Internal Medicine 98: 378–84.Gilbert, RM (1984). Caffeine consumption. In: The Methylxanthines Beverages and Foods: Chemistry,Consumption and Health Effects. Spiller GA, ed. Alan R Liss, New York: 235–301.Gin H, Morlat P, Ragnaud JM, Aubertin J (1992). Short-term effect of red wine (consumed duringmeals) on insulin requirement and glucose tolerance in diabetic patients. Diabetes Care 15: 546–8.Gold AE, MacLeod KM, Frier BM (1994). Frequency of severe hypoglycemia in patients with type Idiabetes with impaired awareness of hypoglycemia. Diabetes Care 17: 697–703.Hagstrom-Toft E, Bolinder J, Ungerstedt U, Arner P (1997). A circadian rhythm in lipid mobilizationwhich is altered in IDDM. Diabetologia 40: 1070–8.Hoi-Hansen T, Pedersen-Bjergaard U, Thorsteinsson B (2005). Reproducibility and reliability ofhypoglycaemic episodes recorded with continuous glucose monitoring system (CGMS) in daily life.Diabetic Medicine 7: 858–62.Jones TW, Porter P, Sherwin RS, Davis EA, O’Leary P, Frazer F et al. (1998). Decreased epinephrineresponses to hypoglycemia during sleep. New England Journal of Medicine 338: 1657–62.Kerr D, Macdonald IA, Heller SR, Tattersall RB (1990). Alcohol causes hypoglycaemic unawareness inhealthy volunteers and patients with Type 1 (insulin-dependent) diabetes. Diabetologia 33: 216–21.Kerr D, Sherwin RS, Pavalkis F, Fayad PB, Sikorski L, Rife F et al. (1993). Effect of caffeine onthe recognition of and responses to hypoglycemia in humans. Annals of Internal Medicine 119:799–804.Kerr D, Cheyne EH, Thomas P, Sherwin RS (2007). Influence of acute alcohol ingestion on thehormonal responses to modest hypoglycaemia in patients with Type 1 diabetes. Diabetic Medicine24: 312–16.Kolaczynski JW, Ylikahri R, Harkonen M, Koivisto VA (1988). The acute effect of ethanol oncounterregulatory response and recovery from insulin-induced hypoglycemia. Journal of ClinicalEndocrinology and Metabolism 67: 384–8.Koivisto VA, Tulokas S, Toivonen M, Haapa E, Pelkonen R (1993). Alcohol with a meal has noadverse effects on postprandial glucose homeostasis in diabetic patients. Diabetes Care 16: 1612–4.Landolt HP, Werth E, Borbely AA, Dijk DJ (1995). Caffeine intake (200 mg) in the morning affectshuman sleep and EEG power spectra at night. Brain Research 675: 67–74.Laurienti PJ, Field AS, Burdette JH, Maldjian JA, Yen YF, Moody DM (2003). Relationship betweencaffeine-induced changes in resting cerebral perfusion and blood oxygenation level-dependent signal.American Journal of Neuroradiology 24: 1607–11.MacCuish AC, Munro JF, Duncan LJP (1970). Treatment of hypoglycaemic coma with glucagon,intravenous dextrose, and mannitol infusion in a hundred diabetics. Lancet ii: 946–9.MacCuish AC (1993). Treatment of hypoglycaemia. In: Hypoglycaemia and Diabetes: Clinical andPhysiological Aspects. Frier BM and Fisher M, eds. Edward Arnold, London: 212–21.
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Hypoglycaemia in Clinical DiabetesS
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Hypoglycaemia in Clinical DiabetesS
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ToEmily, Ben and Marc
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viiiCONTENTS13 Long-term Effects of
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ContributorsProfessor Stephanie A.
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1 Normal Glucose Metabolismand Resp
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NORMAL GLUCOSE HOMEOSTASIS 3Box 1.2
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Fed state (Figure 1.1b)EFFECTS OF G
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COUNTERREGULATION DURING HYPOGLYCAE
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COUNTERREGULATION DURING HYPOGLYCAE
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HORMONAL CHANGES DURING HYPOGLYCAEM
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HORMONAL CHANGES DURING HYPOGLYCAEM
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PHYSIOLOGICAL RESPONSES 15hormones.
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PHYSIOLOGICAL RESPONSES 17Figure 1.
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PHYSIOLOGICAL RESPONSES 19We do not
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REFERENCES 21NORMAL GLUCOSE HOMEOST
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REFERENCES 23Hamilton-Wessler M, Be
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2 Symptoms of Hypoglycaemiaand Effe
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SYMPTOMS OF HYPOGLYCAEMIA 27appeare
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SYMPTOMS OF HYPOGLYCAEMIA 29aware o
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SYMPTOMS OF HYPOGLYCAEMIA 31Table 2
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SYMPTOMS OF HYPOGLYCAEMIA 33frequen
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SYMPTOMS OF HYPOGLYCAEMIA 35Figure
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ACUTE HYPOGLYCAEMIA AND COGNITIVE F
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ACUTE HYPOGLYCAEMIA AND EMOTIONS 43
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REFERENCES 45Bremer JP, Baron M, Pe
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REFERENCES 47McAulay V, Deary IJ, F
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3 Frequency, Causes and RiskFactors
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FREQUENCY OF HYPOGLYCAEMIA 51Box 3.
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Table 3.1 Frequency of mild hypogly
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FREQUENCY OF HYPOGLYCAEMIA 55some i
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FREQUENCY OF HYPOGLYCAEMIA 57Jansse
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Table 3.2 Frequency of severe hypog
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CAUSES OF HYPOGLYCAEMIACAUSES OF HY
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RISK FACTORS FOR SEVERE HYPOGLYCAEM
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RISK FACTORS FOR SEVERE HYPOGLYCAEM
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Page 88 and 89: CONCLUSIONS 75Other Risk FactorsThe
Page 90 and 91: REFERENCES 77Bott S, Bott U, Berger
Page 92 and 93: REFERENCES 79Leckie AM, Graham MK,
Page 94: REFERENCES 81Vervoort G, Goldschmid
Page 97 and 98: Table 4.1 Frequency of nocturnal hy
Page 99 and 100: 86 NOCTURNAL HYPOGLYCAEMIACAUSES OF
Page 101 and 102: 88 NOCTURNAL HYPOGLYCAEMIAPlasma Ep
Page 103 and 104: 90 NOCTURNAL HYPOGLYCAEMIACAN NOCTU
Page 105 and 106: 92 NOCTURNAL HYPOGLYCAEMIABox 4.2 C
Page 107 and 108: 94 NOCTURNAL HYPOGLYCAEMIAconflicti
Page 109 and 110: 96 NOCTURNAL HYPOGLYCAEMIA• Noctu
Page 111 and 112: 98 NOCTURNAL HYPOGLYCAEMIAHolleman
Page 114 and 115: 5 Moderators, Monitoring andManagem
Page 116 and 117: LIFESTYLE MODERATORS 103• absolut
Page 118 and 119: LIFESTYLE MODERATORS 10520 22 24 2
Page 120 and 121: LIFESTYLE MODERATORS 107Growthhormo
Page 122 and 123: LIFESTYLE MODERATORS 109mean change
Page 124 and 125: MONITORING 111flow) while simultane
Page 126 and 127: MONITORING 113• It is unclear whe
Page 128 and 129: MANAGEMENT OF HYPOGLYCAEMIA 115MANA
Page 132 and 133: REFERENCES 119MacDonald MJ (1987).
Page 134 and 135: 6 Counterregulatory Deficienciesin
Page 136 and 137: NORMAL GLUCOSE COUNTERREGULATION 12
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Page 140 and 141: DEFECTIVE HORMONAL GLUCOSE COUNTERR
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Page 144 and 145: MECHANISMS OF COUNTERREGULATORY FAI
Page 146 and 147: AGE, OBESITY AND GLUCOSE COUNTERREG
Page 148 and 149: TREATMENT OF COUNTERREGULATORY FAIL
Page 150 and 151: REFERENCES 137Bingham EM, Dunn JT,
Page 152 and 153: REFERENCES 139McCall AL, Fixman LB,
Page 154 and 155: 7 Impaired Awareness ofHypoglycaemi
Page 156 and 157: NORMAL RESPONSES TO HYPOGLYCAEMIA 1
Page 158 and 159: IMPAIRED AWARENESS OF HYPOGLYCAEMIA
Page 160 and 161: PREVALENCE OF IMPAIRED AWARENESS OF
Page 162 and 163: PATHOGENESIS OF IMPAIRED AWARENESS
Page 172 and 173: Table 7.3 Studies of antecedent hyp
Page 174 and 175: IMPAIRED AWARENESS OF HYPOGLYCAEMIA
Page 176 and 177: TREATMENT STRATEGIES 163or unexplai
Page 178 and 179: CONCLUSIONS 165Box 7.5 Treatment st
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REFERENCES 167Boyle PJ (1997). Alte
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REFERENCES 169Kerr D, Sherwin RS, P
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8 Risks of Strict GlycaemicControlS
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CONTRIBUTORS TO INCREASED RISK OF S
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CONTRIBUTORS TO INCREASED RISK OF S
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CEREBRAL ADAPTATION 177severe, are
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CEREBRAL ADAPTATION 179hypoglycaemi
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THERAPEUTIC MANIPULATION 181Figure
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PATIENTS UNSUITABLE FOR STRICT CONT
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REFERENCES 185It is the patient who
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REFERENCES 187Egger M, Davey Smith
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REFERENCES 189Simonson DC, Tamborla
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192 HYPOGLYCAEMIA IN CHILDREN WITH
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Table 9.2 Summary of studies examin
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10 Hypoglycaemia in PregnancyAnn E.
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FREQUENCY OF HYPOGLYCAEMIA IN DIABE
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FREQUENCY OF HYPOGLYCAEMIA IN DIABE
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CLINICAL MANAGEMENT BEFORE AND DURI
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Figure 10.2 Example of home blood g
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MATERNAL COMPLICATIONS OF DIABETES
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COMPLICATIONS IN THE INFANT OF THE
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REFERENCES 235Akazawa M, Akazawa S,
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REFERENCES 237Ray JG, O’Brien TE,
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240 HYPOGLYCAEMIA IN TYPE 2 DIABETE
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Table 11.2a Prevalence of severe hy
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266 MORTALITY, CARDIOVASCULAR MORBI
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13 Long-term Effects ofHypoglycaemi
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COGNITIVE FUNCTION AND HYPOGLYCAEMI
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FUNCTIONAL EFFECTS OF HYPOGLYCAEMIA
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STRUCTURAL AND FUNCTIONAL CHANGES I
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REFERENCES 303disease (Fisher and F
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REFERENCES 305Fisher M, Frier BM (1
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REFERENCES 307Seidl R, Birnbacher R
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310 LIVING WITH HYPOGLYCAEMIAPSYCHO
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312 LIVING WITH HYPOGLYCAEMIABox 14
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314 LIVING WITH HYPOGLYCAEMIAprophy
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316 LIVING WITH HYPOGLYCAEMIAMost t
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318 LIVING WITH HYPOGLYCAEMIAfor pu
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320 LIVING WITH HYPOGLYCAEMIAVocati
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322 LIVING WITH HYPOGLYCAEMIAif the
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324 LIVING WITH HYPOGLYCAEMIAestabl
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326 LIVING WITH HYPOGLYCAEMIAwith g
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328 LIVING WITH HYPOGLYCAEMIAalcoho
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330 LIVING WITH HYPOGLYCAEMIAChante
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332 LIVING WITH HYPOGLYCAEMIASonger
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334 INDEXanterior pituitary gland,
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336 INDEXcomplications due to diabe
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338 INDEXemployment aspects, 323-32
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340 INDEXhypopituitarism, 74, 102,
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342 INDEXmood changes due to hypogl
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344 INDEXpsychological factors, and
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346 INDEXtrain drivers, 323, 324tra
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