A study published in "Diabetes Care" found that subjects with diabetes were hypoglycemic approximately eight percent of the day. The frequency and duration of hypoglycemia was higher in type 1 diabetics than in type 2 diabetics. The symptoms of hypoglycemia range from mild to severe and may result in the loss of consciousness and brain damage. An acute state of hypoglycemia with blood glucose levels in the range of 50 to 65 mg/deciliter can result in short-term cognitive impairment. However, a study published in the "New England Journal of Medicine," in which over 1,000 type 1 diabetics were studied, concluded that long-term cognitive impairment is not associated with recurrent episodes of hypoglycemia.
Guidelines
The American Diabetes Association recommends that fasting blood glucose levels stay in the range of 70 to 130 mg/dL. As reported in the May 2005 issue of "Diabetes Care," the symptoms of nervousness, sweating, trembling, weakness and intense hunger may occur in persons with glucose levels below 70 mg/dL. If blood glucose levels continue to drop, symptoms may progress to confusion, coma and seizures.
Causes
The treatment of type 1 and type 2 diabetes aims to reduce blood glucose levels. A side effect of anti-diabetic drugs and insulin therapy is hypoglycemia. A study published in a 2001 issue of "Archives of Internal Medicine" stated that aggressive diabetes management results in more episodes of mild hypoglycemia, but severe hypoglycemia is rare. The authors of a study published in the November 2001 issue of "Diabetes Care" suggested that individuals who attempted "perfect" glucose control experience frequent but mild episodes of hypoglycemia. In contrast, type 1 diabetics who did not achieve good glucose control had episodes of severe hypoglycemia.
Diabetes Treatment
The study published in "Diabetes Care" that found that subjects with diabetes were hypoglycemic approximately eight percent of the day also found that they were hyperglycemic nearly 30 percent of the day. Because of the risk of cardiovascular disease and other complications of diabetes, the main goal of treatment for diabetes remains to reduce blood glucose levels. New methodologies for the treatment of diabetes and more effective glucose monitoring aim to reduce the risk of hypoglycemia while still decreasing average blood glucose concentration.
New Treatments
A 2008 study in "Acta Diabetologia" reports that newer insulin analogs that are longer acting achieve glycemic control and reduce the risk of hypoglycemia. A review article published in "Drugs" states the newer oral anti-diabetic drugs, including incretin mimetics, DPP-4 inhibitors, and the amylin analogue pramlintide, also have been found to be effective glucose-lowering agents without increasing the frequency of hypoglycemia.
Continuous Glucose Monitors
Continuous glucose monitors are a new device to assess glycemic control and are used in conjunction with intermittent self-monitoring of blood glucose. A small glucose sensor inserts under the skin. The sensor attaches to a transmitter that wirelessly displays real-time glucose levels on a small monitor worn on a belt or inside a pocket. A study published in the October 2009 issue of "Diabetes Technology and Therapeutics" found that continuous glucose monitors significantly decreased the frequency of hypoglycemia in type 1 diabetics.
References
- "Diabetes Care": Glycemic Characteristics in Continuously Monitored Patients With Type 1 and Type 2 Diabetes
- "New England Journal of Medicine": Long-Term Effect of Diabetes and Its Treatment on Cognitive Function
- Diabetes.org: Tight Diabetes Control
- "Diabetes Care": Defining and Reporting Hypoglycemia in Diabetes
- archinte.ama-assn.org: "Archives of Internal Medicine": Hypoglycemia in Patients With Type 2 Diabetes Mellitus
