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- May 17, 2008 |
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"Hypoglycemia in Type 2 Diabetes: Impact and Management"Dr. Amir Hanna (biography)
English - 2002-10-05 - 17 minutes
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 | (25 slides) |
Summary :
One of the major obstacles in attaining euglycemia in type 2 diabetes is the increased risk of hypoglycemia. This concern results in clinicians and patients accepting blood glucose levels below the normal range.
The CDA clinical practice guidelines for the prevention and management of hypoglycemia in diabetes were recently published *.
These guidelines identified factors predisposing an individual to antihyperglycemic drug-induced hypoglycemia. The elderly with impaired kidney or liver function, alcohol consumption, and the use of specific antihyperglycemic agents and other medications are among the major contributing factors.
Recommendations to reduce the risk of hypoglycemia are made. These recommendations should be utilized in an effort to reach treatment goals without subjecting the high-risk patient to the sequelea of hypoglycemia.
* Yale JF, Begg I, Gerstein H et al. 2002. Canadian Diabetes Association Clinical Practice Guidelines for the prevention of Hypoglycemia in Diabetes. Can J Diabetes 26: 22-35.
Learning objectives :
The participant will learn which treatment therapies and antihyperglycemic drugs when used cause the patient to be more hypoglycemia prone. Treatment recommendations for hypoglycemia are also outlined.
Bibliographic references :
Prolonged sulfonylurea-induced hypoglycemia in diabetic patients with end-stage renal disease.
Krepinsky J, Ingram AJ, Clase CM.
McMaster University, Hamilton, Ontario, Canada.
Renal impairment is a recognized risk factor for prolonged hypoglycemia, but predisposing characteristics in patients with advanced renal impairment have not been studied. We observed prolonged hypoglycemia in a number of patients with end-stage renal disease (ESRD) and conducted a case-control study at two Canadian centers to identify such risk factors. Through hospital, pharmacy, and dialysis program records, we retrospectively identified 7 case patients and 31 controls with ESRD and type 2 diabetes using oral hypoglycemic monotherapy. Control patients had no history of hospital admission for prolonged hypoglycemia. All case patients and 28 controls were receiving glyburide (glibenclamide in Europe); the remainder were treated with tolbutamide. Duration of intravenous treatment for hypoglycemia ranged from 28 to 256 hours, with 83 g to 2 kg of glucose administered per episode. Preceding treatment with glyburide varied from 2 days to 13 years. Univariate analyses showed a recent decline in oral intake (odds ratio [OR], 81; 95% confidence interval [CI], 3.6 to 1,840), previous hypoglycemic episodes (OR, 15; 95% CI, 0.77 to 297), longer duration of diabetes (22 versus 12 years; P = 0.008), and a history of cerebrovascular disease (OR, 7. 0; 95% CI, 1.0 to 47) to be associated with prolonged hypoglycemia. No association between prolonged hypoglycemia and age, sex, beta blockers, angiotensin-converting enzyme inhibitors, oral hypoglycemic dose, or duration of treatment was identified. This study describes the potentially devastating effect of sulfonylurea-based oral hypoglycemic therapy in ESRD. Patients at greatest risk appear to be those with reduced intake, previous hypoglycemic episodes, and longer duration of diabetes. We describe the mechanisms for observed hypoglycemia and suggest that alternative drugs may be considered in this patient group.
Am J Kidney Dis 2000 Mar;35(3):500-5
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