Hypoglycemia awareness

Sawka AM, Buigart V, Zimmerman D. Loss of hypoglycemia awareness in an adolescent with type 1 diabetes melUtus during treatment with fluoxetine hydrochloride. J Pediatr (2000) 136, 394-6. 

Clarke WL, Cox DJ, Gonder-Frederick LA, Julian D, Schlundt D, Polonsky W. The relationship between no routine use of insulin, food, and exercise and the occurrence of hypoglycemia in adults with IDDM and varying degrees of hypoglycemic awareness and metabolic control. Diabetes Educator 1997 23 55-8. 

Since the bronchial tonus is under the relaxant influence of 62-adrenoceptor stimulation, especially unselective jS-blockers increase the respiratory resistance. In susceptible patients this might induce airway obstruction or even acute asthma. The blockade of jS2-adrenoceptors inhibits the mobilization of free fatty acids and glucose. This might result in hypoglycemia in diabetic patients. Furthermore, these patients will be not aware of the danger since most of the sympathetically mediated alerting symptoms like tachycardia are suppressed by the jS-blockers as well. jSi-Selective blockers show this type of side-effect less pronounced than unselective compounds. 

Be aware of the typical signs and symptoms of hypoglycemia and hyperglycemia... 

Rapid development of hypoglycemia in persons with intact hypoglycemic awareness causes signs of autonomic hyperactivity—both sympathetic (tachycardia, palpitations, sweating, tremulousness) and parasympathetic (nausea, hunger)—and may progress to convulsions and coma if untreated. 

A retrospective questionnaire was sent to 195 consecutive patients addressing questions of severe hypoglycemia, coma, awareness of hypoglycemia, and fear of hypoglycemia (64). The mean duration of diabetes was 20 years and 82% had received intensive therapy. Coma was reported in 19% and severe hypoglycemia in 41%. 

Impaired hypoglycemic awareness was associated with an increased rate of severe hypoglycemia in 130 children and adolescents (aged 3-17 years) (90). One-third of the severe episodes developed without warning symptoms. Impaired awareness, young age, and recent attacks of hypoglycemia were independent susceptibility factors. 

The authors of a systematic review of whether there is a difference in the frequency and awareness of hypoglycemia induced by human or animal insulins identified 52 randomized, controlled trials 37 were double-blind (91). They found no support for the supposition that human insulin per se affects the frequency, severity, or symptoms of hypoglycemia. In a few studies, mainly of less rigorous design, there was an effect when people were transferred from animal to human insulin, indicating increased frequency or reduced awareness of hypoglycemia. 

Pohl J, Frohnau G, Kerner W, Fehm-Wolfsdorf G. Symptom awareness is affected by the subjects expectations during insulin-induced hypoglycemia. Diabetes Care 1997 20(5) 796-802. 

Cox DJ, Gonder-Frederick LA, Kovatchev BP, Julian DM, Clarke WL. Progressive hypoglycemia s impact on driving simulation performance. Occurrence, awareness and correction. Diabetes Care 2000 23(2) 163-70. 

Kinsley BT, Weinger K, Bajaj M, Levy CJ, Simonson DC, Quigley M, Cox DJ, Jacobson AM. Blood glucose awareness training and epinephrine responses to hypoglycemia during intensive treatment in type 1 diabetes. Diabetes Care 1999 22(7) 1022-8. 

A questionnaire about the prevalence of severe hypoglycemia in relation to susceptibility factors was answered by 387 patients in 1984 and by 641 patients in 1998 178 patients answered both questionnaires (74). The following changed significantly from 1984 to 1998 multiple injection therapy increased from 71 to 98%, daily selfmonitoring from 17 to 48%, episodes of nocturnal hypoglycemia from 76 to 83%, and lack of awareness from 40 to 55% HbAic fell from 7.6 to 7.4%. 

Diabetics on insulin therapy should be aware that early signs of hypoglycemia may be masked by the... 

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