Diabetes, Heart and Cardiovascular Diseases News Chronicle.  Diabetes, Cardiovascular and Heart Diseases
 Article 327
    Published on April 24, 2018

 

Patients With Type 2 Diabetics Need To Be More Aware Of The Risks, Signs And Symptoms Of Hypoglycemia

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Even though the hypoglycemia is associated with the patients with type 1 diabetes (T1D), experts say that the patients with type 2 diabetes (T2D) are also at a greater risk of extremely low blood sugar (glucose) levels (hypoglycemia).


Researchers have suggested the 'Hypoglycemia Risk Stratification Tool' from the Kaiser Permanente to identify the hypoglycemia.

The National Institute of Diabetes and Digestive and Kidney Diseases defines the hypoglycemia as a condition where the blood sugar (glucose) levels drop below 70 mg/dL. The following patients with type 2 diabetes are at a greater risk for hypoglycemia.


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  • Patients taking insulin.
  • Patients aged more than 65 years.
  • Patients using sulfonylureas.
  • In those people who
    1. Consume alcohol.
    2. Do exercise or workout for more than usual time.
    3. Ate less than usual during one or more meals.

Patients with type 1 diabetes use a continuous glucose monitoring (CGM) device to prevent hypos (hypoglycemia or hyperglycemia). Hypos can significantly affect the patient's quality of life, the capability to drive safely, daily work and social life.

A severe hypo (hypoglycemia or hyperglycemia) is classified as a medical emergency. The American Diabetes Association (ADA) says that the hypoglycemia can cause serious health complications to a patient with diabetes such as the life-threatening unconsciousness (diabetic coma), changes in the electrical activity in the brain (seizures) and even a death (mortality).



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A study shows that the failure to detect hypoglycemia are too often in the people with type 2 diabetes. The researchers have reviewed a number of articles, clinical guidance documents (20), quality measures (34) and clinician and diagnostic tools (more than 50) to know the frequency of the hypoglycemia and the subsequent health outcomes in patients with type 2 diabetes. Researchers have observed the following in the study.

  • There were about 300,000 emergency room visits due to hypoglycemia among patients with type 1 and type 2 diabetes in 2009.
  • About 18.1 percent of the patients hospitalized due to hypoglycemia during 2010 were readmitted within 30 days with the same reason. About five percent of the patients died within a month (30-day mortality rate is five percent).

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In a meta-analysis of the insulin based patients with type 2 diabetes, researchers have found 23 patients with a moderate hypoglycemia and one patient with a severe hypoglycemia per year, indicating that even the patients with type 2 diabetes were affected with the hypoglycemia. Hypoglycemia is categorized into the following categories for the awareness of a patient and for the healthcare professional to prevent the health complications.



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Category Description
Level 1 Patient may not know that his/her blood sugar level is less than 70 mg/dL. A condition is known as hypoglycemia unawareness. A hypoglycemia without any warning.
Level 2 The blood sugar level is less than 54 mg/dL. A hypoglycemia can cause serious health complications.
Level 3 Independent of the blood sugar (glucose) levels. The patient may be in a serious mental illness or physically impaired. The patient may require assistance.

Researchers say that the importance of hypoglycemia in patients with type 2 diabetes were not recognized and not taken care by the healthcare professionals. The healthcare professional may pay more attention to lower the high blood sugar (glucose) levels (HbA1c) in patients with type 2 diabetes and increases the risk of hypoglycemia.


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The researchers have observed that there are no tools to assist healthcare professionals in identifying, assessing and managing the patients with diabetes who are at a risk to hypoglycemia. They say that the following risk assessment tools can help healthcare professionals in addressing the hypoglycemia in the patients.

  • A Quality Improvement Program to Reduce Potential Overtreatment of Diabetes Among Veterans at High Risk of Hypoglycemia. DOI: doi.org/10.2337/ds16-0006
  • Hypoglycemia Risk Stratification Tool, developed by the Kaiser Permanente, United States in a partnership with the FDA. This tool can identify 156 possible risk factors to hypoglycemia.

Authors say that this study is a first step in establishing more accurate guidelines for the diagnosis and treatment of hypoglycemia in patients with type 2 diabetes. They also suggest that a patient with type 2 diabetes as well as the healthcare professional who is providing a treatment to a patient with type 2 diabetes should know the risks, signs and symptoms associated with the hypoglycemia.


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The lead author of the study was Dr. Robert W. Lash, MD, an endocrinologist, chief professional and clinical affairs officer, Endocrine Society, Washington, DC, United States. The study was published March 5, 2018, in the Journal of Clinical Endocrinology & Metabolism. Title of the article was "Preventing Hypoglycemia in Type 2 Diabetes." DOI: doi.org/10.1210/jc.2017-02804



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Sulfonylureas: The sulfonylureas (a class of drugs) can improve the secretion of the insulin from the beta cells in the pancreas.


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