Hypoglycemia primary prevention: Difference between revisions
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== Primary Prevention== | == Primary Prevention== | ||
=== Patient education:<ref name="pmid24319119">{{cite journal| author=de Zoysa N, Rogers H, Stadler M, Gianfrancesco C, Beveridge S, Britneff E et al.| title=A psychoeducational program to restore hypoglycemia awareness: the DAFNE-HART pilot study. | journal=Diabetes Care | year= 2014 | volume= 37 | issue= 3 | pages= 863-6 | pmid=24319119 | doi=10.2337/dc13-1245 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24319119 }}</ref> === | === Patient education:<ref name="pmid24319119">{{cite journal| author=de Zoysa N, Rogers H, Stadler M, Gianfrancesco C, Beveridge S, Britneff E et al.| title=A psychoeducational program to restore hypoglycemia awareness: the DAFNE-HART pilot study. | journal=Diabetes Care | year= 2014 | volume= 37 | issue= 3 | pages= 863-6 | pmid=24319119 | doi=10.2337/dc13-1245 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24319119 }}</ref> === | ||
The main pillar in primary prevention is to educate the patient about | The main pillar in primary prevention is to educate the patient about symptoms and treatment. | ||
* | * Patient should be able to recognize early symptoms. | ||
* Frequent self-monitoring of blood [[glucose]]:<ref name="pmid23589524">{{cite journal| author=Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L et al.| title=Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. | journal=J Clin Endocrinol Metab | year= 2013 | volume= 98 | issue= 5 | pages= 1845-59 | pmid=23589524 | doi=10.1210/jc.2012-4127 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23589524 }}</ref> | * Frequent self-monitoring of blood [[glucose]]:<ref name="pmid23589524">{{cite journal| author=Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L et al.| title=Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. | journal=J Clin Endocrinol Metab | year= 2013 | volume= 98 | issue= 5 | pages= 1845-59 | pmid=23589524 | doi=10.1210/jc.2012-4127 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23589524 }}</ref> | ||
** Continuous glucose monitoring may facilitate glycemic control avoiding frequent punctures and providing the records over days or weeks depending upon the device used. | ** Continuous glucose monitoring may facilitate glycemic control avoiding frequent punctures and providing the records over days or weeks depending upon the device used. | ||
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* Bedtime snacks are the best way to prevent nocturnal hypoglycemia.<ref name="pmid8636359">{{cite journal| author=Gray RO, Butler PC, Beers TR, Kryshak EJ, Rizza RA| title=Comparison of the ability of bread versus bread plus meat to treat and prevent subsequent hypoglycemia in patients with insulin-dependent diabetes mellitus. | journal=J Clin Endocrinol Metab | year= 1996 | volume= 81 | issue= 4 | pages= 1508-11 | pmid=8636359 | doi=10.1210/jcem.81.4.8636359 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8636359 }}</ref> | * Bedtime snacks are the best way to prevent nocturnal hypoglycemia.<ref name="pmid8636359">{{cite journal| author=Gray RO, Butler PC, Beers TR, Kryshak EJ, Rizza RA| title=Comparison of the ability of bread versus bread plus meat to treat and prevent subsequent hypoglycemia in patients with insulin-dependent diabetes mellitus. | journal=J Clin Endocrinol Metab | year= 1996 | volume= 81 | issue= 4 | pages= 1508-11 | pmid=8636359 | doi=10.1210/jcem.81.4.8636359 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8636359 }}</ref> | ||
* Sensor-augmented [[insulin]] | * Sensor-augmented [[insulin]] pump is a method to measure blood [[glucose]] level during sleeping frequently and stop [[insulin]] injection in response to hypoglycemia.<ref name="pmid23789889">{{cite journal| author=Bergenstal RM, Klonoff DC, Garg SK, Bode BW, Meredith M, Slover RH et al.| title=Threshold-based insulin-pump interruption for reduction of hypoglycemia. | journal=N Engl J Med | year= 2013 | volume= 369 | issue= 3 | pages= 224-32 | pmid=23789889 | doi=10.1056/NEJMoa1303576 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23789889 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24042390 Review in: Ann Intern Med. 2013 Sep 17;159(6):JC7]</ref> | ||
=== Exercise can cause hypoglycemia in patients with insulin-deficient diabetes.<ref name="pmid12766131">{{cite journal| author=Cryer PE, Davis SN, Shamoon H| title=Hypoglycemia in diabetes. | journal=Diabetes Care | year= 2003 | volume= 26 | issue= 6 | pages= 1902-12 | pmid=12766131 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12766131 }}</ref> === | === Exercise can cause hypoglycemia in patients with insulin-deficient diabetes.<ref name="pmid12766131">{{cite journal| author=Cryer PE, Davis SN, Shamoon H| title=Hypoglycemia in diabetes. | journal=Diabetes Care | year= 2003 | volume= 26 | issue= 6 | pages= 1902-12 | pmid=12766131 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12766131 }}</ref> === | ||
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=== The most effective means of preventing further episodes of hypoglycemia depends on the cause: === | === The most effective means of preventing further episodes of hypoglycemia depends on the cause: === | ||
* The risk of further episodes of [[diabetic hypoglycemia]] can often be reduced by | * The risk of further episodes of [[diabetic hypoglycemia]] can often be reduced by decreasing the insulin dose or other medications. Meticulous attention to [[blood sugar]] balance during unusual hours, higher levels of exercise, or [[Alcohol-Induced cardiomyopathy|alcohol]] intake are other important measures. | ||
* Monitor for inappropriate prescribing. | * Monitor for inappropriate prescribing. | ||
* Many of [[inborn error of metabolism|inborn errors of metabolism]] require avoiding or shortening of fasting intervals or taking extra [[Carbohydrate|carbohydrates]]. | |||
* Many of | |||
* For the more severe disorders, such as [[glycogen storage disease|type 1 glycogen storage disease]], this may be supplied in the form of cornstarch every few hours or by continuous gastric infusion. | * For the more severe disorders, such as [[glycogen storage disease|type 1 glycogen storage disease]], this may be supplied in the form of cornstarch every few hours or by continuous gastric infusion. | ||
* Hypoglycemia due to [[dumping syndrome]]: | * Hypoglycemia due to [[dumping syndrome]]: Mixed diets including [[fat]] and [[protein]] with [[Carbohydrate|carbohydrates]] may slow digestion and reduce early [[insulin]] secretion. [[Glucosidases|Glucosidase]] inhibitor which slows [[starch]] digestion are helpful in this conditions. | ||
* [[Reactive hypoglycemia]]: | * [[Reactive hypoglycemia]]: Change eating patterns by taking smaller meals, avoiding excessive sugar intake and mixed meals. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 17:09, 17 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
The main issue is patient education about nature, symptoms, how to measure glucose level and how to treat hypoglycemia. Reactive hypoglycemia prevention depends on changing eating patterns smaller meals and avoiding excessive sugar intake.
Primary Prevention
Patient education:[1]
The main pillar in primary prevention is to educate the patient about symptoms and treatment.
- Patient should be able to recognize early symptoms.
- Frequent self-monitoring of blood glucose:[2]
- Continuous glucose monitoring may facilitate glycemic control avoiding frequent punctures and providing the records over days or weeks depending upon the device used.
- It should be more restricted for patients using alcohol and B-blockers as B-blockers mask symptoms of hypoglycemia.
- Glycemic control can minimize complications and prevent cardiovascular events.[3]
- Long-acting insulin, mixed with short-acting ones as the pre-meal bolus insulin, reduce the risk of hypoglycemia especially before meals and sleep.
- Bedtime snacks are the best way to prevent nocturnal hypoglycemia.[4]
- Sensor-augmented insulin pump is a method to measure blood glucose level during sleeping frequently and stop insulin injection in response to hypoglycemia.[5]
Exercise can cause hypoglycemia in patients with insulin-deficient diabetes.[6]
- Frequent self-monitoring of blood glucose
- Reduce insulin doses before exercise
- Carbohydrate ingestion before exercise
The most effective means of preventing further episodes of hypoglycemia depends on the cause:
- The risk of further episodes of diabetic hypoglycemia can often be reduced by decreasing the insulin dose or other medications. Meticulous attention to blood sugar balance during unusual hours, higher levels of exercise, or alcohol intake are other important measures.
- Monitor for inappropriate prescribing.
- Many of inborn errors of metabolism require avoiding or shortening of fasting intervals or taking extra carbohydrates.
- For the more severe disorders, such as type 1 glycogen storage disease, this may be supplied in the form of cornstarch every few hours or by continuous gastric infusion.
- Hypoglycemia due to dumping syndrome: Mixed diets including fat and protein with carbohydrates may slow digestion and reduce early insulin secretion. Glucosidase inhibitor which slows starch digestion are helpful in this conditions.
- Reactive hypoglycemia: Change eating patterns by taking smaller meals, avoiding excessive sugar intake and mixed meals.
References
- ↑ de Zoysa N, Rogers H, Stadler M, Gianfrancesco C, Beveridge S, Britneff E; et al. (2014). "A psychoeducational program to restore hypoglycemia awareness: the DAFNE-HART pilot study". Diabetes Care. 37 (3): 863–6. doi:10.2337/dc13-1245. PMID 24319119.
- ↑ Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L; et al. (2013). "Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society". J Clin Endocrinol Metab. 98 (5): 1845–59. doi:10.1210/jc.2012-4127. PMID 23589524.
- ↑ Cryer PE (2014). "Glycemic goals in diabetes: trade-off between glycemic control and iatrogenic hypoglycemia". Diabetes. 63 (7): 2188–95. doi:10.2337/db14-0059. PMID 24962915.
- ↑ Gray RO, Butler PC, Beers TR, Kryshak EJ, Rizza RA (1996). "Comparison of the ability of bread versus bread plus meat to treat and prevent subsequent hypoglycemia in patients with insulin-dependent diabetes mellitus". J Clin Endocrinol Metab. 81 (4): 1508–11. doi:10.1210/jcem.81.4.8636359. PMID 8636359.
- ↑ Bergenstal RM, Klonoff DC, Garg SK, Bode BW, Meredith M, Slover RH; et al. (2013). "Threshold-based insulin-pump interruption for reduction of hypoglycemia". N Engl J Med. 369 (3): 224–32. doi:10.1056/NEJMoa1303576. PMID 23789889. Review in: Ann Intern Med. 2013 Sep 17;159(6):JC7
- ↑ Cryer PE, Davis SN, Shamoon H (2003). "Hypoglycemia in diabetes". Diabetes Care. 26 (6): 1902–12. PMID 12766131.