Hypoglycaemia in Clinical Diabetes

342 INDEXmood changes due to hypoglycaemia, 43, 314in examinations [academic], 326, 327recovery from, 293morbidity of hypoglycaemia, 255–256type 2 diabetes, 256mortality, 270risk factors, 267–272motor skills, effect of hypoglycaemia, 38multiple injection therapychildren and adolescents, 199compared with CSII, 180, 181adolescents, 208and nocturnal hypoglycaemia, 84, 85and severe hypoglycaemia, 65, 181, 182treatment of counterregulatory failure, 135musclechanges in blood flow duringhypoglycaemia, 17−18, 17metabolic pathways, 2, 3,4, 5,200sympathetic activity, 11–12myocardial infarction, 279myocardial ischaemia, 278–280nateglinide, 250nausea (symptom), 26, 30in children, 32 196neonates, risks of maternal hypoglycaemia,232–234nephropathy, 73, 279in diabetic pregnancy, 227, 232reduction in risk, 184nervous system, see autonomic nervous system;central nervous system (CNS)nervousness (symptom), 26, 27, 29, 31neuroendocrine activation duringhypoglycaemia, 13–15neuroglycopenic symptoms, 30, 31, 143–144,196blood glucose threshold(s), 29, 50, 142, 151in children, 32 196, 327compared with autonomic symptoms, 144confusion with alcohol intoxication, 62and detection of hypoglycaemia, 35–36,142–143in exam situations, 326in older people, 240neurological symptoms, in older people, 240,240neurological syndromes,hypoglycaemia-induced, 289–290neurophysiological dysfunction, blood glucosethresholds, 50, 142neuropsychological deterioration due to severehypoglycaemiaevidence for, 289–290long-term manifestations, 295–296transient manifestations, 290nocturnal hypoglycaemiaadvice to patients, 276caffeine-associated reduction, 110causes, 74, 86–88in children, 197and cognitive function, 204effect of exercise, 201, 209clinical solutions, 92–95continuous subcutaneous insulin infusion,95, 183dietary approach, 92–94, 208pharmaceutical interventions, 94timing and type of insulin, 94–95, 163,183, 206, 227, 228consequences, 88–89effect of exercise, 200, 315epidemiology, 63, 76, 83–85frequency, 84and impaired awareness, 74, 88–89, 200neurological consequences, 89prediction of, 90in children, 206in pregnancy, 219sudden death associated with, 83, 89, 267,271–273, 274, 278typical overnight glucose profiles, 85 122nocturnal insulin requirements, 95for children, 199novel insulins, see insulin analoguesobese people, counterregulatory responses, 134observational data, effect of intensive therapyon severe hypoglycaemia, 66, 72‘odd behaviour’ (symptom), 30, 31, 32, 43, 196in children, 32mistaken for alcohol inebriation, 327offshore oil industry, employment in, 324older peoplecounterregulatory responses, 134, 241–242symptoms of hypoglycaemia, 33, 239–240,240blood glucose thresholds, 240, 241unsuitability for strict glycaemic control, 184,185