Insulin therapy hypoglycaemia

Kaneto H, Ikeda M, Kishimoto M, Iida M, Hoshi A, Watarai T, Kubota M, Kajimoto Y, Yamasaki Y, Hori M. Dramatic recovery of counter-regulatory hormone response to hypoglycaemia after intensive insulin therapy in poorly controlled type I diabetes mellitus. Diabetologia 1998 41(8) 982-3. 

Hypoglycaemia is the most common adverse effect with sulphonylureas, but is less common than with insulin therapy. It can be severe, and prolonged (for days), and may be fatal in 10% of cases, especially in the elderly and in patients with heart failure. Erroneous alternate diagnoses such as stroke may be made. 

The most frequent complication of insulin therapy is hypoglycaemia, the speed of onset and duration of which may vary according to the type of... 

Iatrogenic hypoglycaemia and hypokalaemia are common and preventable, provided there is access to rapid analysis of glucose and potassium and -not less important - a competent and experienced medical team. Another frequent comphcation is recurrence of DKA or unnecessary protraction of the course, typically due to insufficient insulin therapy. Thrombotic events are also not uncommon although more often in HH than DKA. 

Ratner RE, Hirsch IB, Neifing JL, Garg SK, Mecca TE, Wilson CA. Less hypoglycaemia with insulin glargine in intensive insulin therapy for Type 1 diabetes. Diabetes Care 2000 23 639-643. 

The development of inhaled insulin must be seen in the light of a substantial resistance to insulin therapy in patients with type 2 diabetes and physicians who care for the patients. The reasons for this resistance include anticipated pain, inconvenience, fear of hypoglycaemia and weight gain [55,56]. 

Metabolism Hypoglycaemia In a single-centre, double-blind, randomised, placebo-controlled crossover study, 28 type 1 diabetes patients were treated with vildagliptin 50 mg twice daily as an add-on to their insulin therapy for 4 weeks. Four patients reported mild hypoglycaemia, two with vildagliptin, one with placebo and one during the washout period. [45 ]... 

Insuhn therapy may be required in the control of type II diabetes. InsuUn is given by subcutaneous injection, usually several times a day in an attempt to mimic the normal physiological variation. The most serious risk with insulin therapy is that of hypoglycaemia. Hypoglycaemia develops if insulin is injected and not followed by a meal and is a medical emergency. Fat hypertrophy may occur if insulin is continually injected into the same site. Rotation of the sites of injection is therefore advised (30c). 

Linkeschova R, Raoul M, Bott U, Berger M, Spraul M. Less severe hypoglycaemia, better metabolic control, and improved quality of life in type 1 diabetes mellitus with continuous subcutaneous insulin infusion (CSII) therapy an observational study of 100 consecutive patients followed for a mean of 2 years. Diabet Med 2002 19(9) 746-51. 

Tupola S, Rajantie J. Documented symptomatic hypoglycaemia in children and adolescents using multiple daily insulin injection therapy. Diabet Med 1998 15(6) 492-6. 

---