Hypoglycaemia in Clinical Diabetes

INDEX 337dextrose (glucose) intravenous solution,115–116Diabetes Control and Complications Trial(DCCT)children, severe hypoglycaemia, 194, 197cognitive function affected byhypoglycaemia, 289complications of type 1 diabetes, 49, 63definition of severe hypoglycaemia, 51HbA 1c as risk factor for severehypoglycaemia, 67–68, 121hypoglycaemia in pregnancy, 217intensive compared with conventional insulintherapy, 65, 66, 172in pregnant women, 226–227, 228nocturnal hypoglycaemia, 73risk factors examined, 64subjects in trial, 52, 65, 302vascular complications reduced, 183Diabetes in Early Pregnancy (DIEP) study, 219Diabetes UKon blood glucose lower limit, 50, 114, 173,191on sudden unexpected deaths, 268diabetic encephalopathy, 285, 302–303diabetic ketoacidosis (DKA)deaths due to, 267, 269, 270as side effect of intensive insulin therapy, 179worry about, 205diabetic pregnancy, see also pregnancyclinical management in, 223–229combined diabetic antenatal charts, 224−225counterregulatory responses, 221, 222frequency of hypoglycaemia, 217–220insulin regimens in, 226–229management of delivery, 230reasons for greater risk of hypoglycaemia,220–222timing of delivery, 230diet, as risk factor in children, 199dietary advice/interventionin diabetic pregnancy, 228in nocturnal hypoglycaemia, 92–94, 208dipeptidyl peptidase IV (DPP-IV) inhibitors,255disobedience (symptom), in children, 33, 312dizziness (symptom), 26, 27, 29children, 32 196older people, 240Dose Adjustment For Normal Eating (DAFNE)trial, 172doses of insulin, effects on hypoglycaemic risk,73Driver and Vehicle Licensing Agency (DVLA),notifications, 319drivingadvice for diabetic drivers, 320–322advice on alcohol consumption, 108effect of hypoglycaemia, 41–42, 231, 318and risk of accidents, 318–319medico-legal aspects, 322by pregnant women, 231reasons to cease, 321driving licencesrestriction of, 318vocational, 320drowsiness (symptom), 26, 30,31, 196children, 32 196, 196, 327difficulty in interpreting, 144older people, 240drug, insulin [treated in law] as, 321–322duration of insulin therapyand defective responses to hypoglycaemia,131, 132and mild hypoglycaemia 55impaired awareness of hypoglycaemiaaffected by, 69, 147, 148as risk factor for severe hypoglycaemia, 64,68, 69–70, 102type 2 diabetes, 252, 253, 254early-warning symptoms, 27, 29, 30, 144actions taken by patient, 114Edinburgh Hypoglycaemia Scale, 37symptom groupings and classification, 30, 31education/training programmes, 34, 66, 67, 121,122, 135, 183for children, 207–208elderly people, see older peopleelectrocardiogram (ECG), QT intervalmeasurements, 274, 275electroencephalograms (EEG)children with diabetes, 287, 292limitations in diagnosing convulsions, 295emergency servicesemployment, 320, 324and severe hypoglycaemia, 58, 60,115–116type 1 compared with type 2 diabetes, 255emotions during hypoglycaemia, 43–44,312–313