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Preventing hypoglycemia in patients with diabetes

Hypoglycemia is one of the most important barrier in achievement of good glycemic control. Furthermore, hypoglycemia is the most common acute complication of diabetes. There are three main types of hypoglycemia: asymptomatic hypoglycemia, symptomatic hypoglycemia and severe hypoglycemia. Risk factors for hypoglycemia are sulfonylurea therapy, insulin therapy, increased or unusual physical exercise, delaying or missing a meal and alcohol consumption. Previously experienced hypoglycemic episode is a risk factor for repeated episodes. Patients with long duration of type 1 or type 2 diabetes, especially those without warning symptoms have increased risk of severe hypoglycemic episodes. Severe hypoglycemia increases the risk of cardiovascular diseases and mortality. On the other hand, repeated episodes of severe hypoglycemia increase risk of cognitive dysfunction. Older patients with diabetes, due to higher risk of hypoglycemia, have increased risk for falls, fall-related fractures and cardiovascular events. This risk could be minimalized by modifying glycemic goals and choosing appropriate anti-hyperglycemic therapy. Novel oral and injectable anti-hyperglycemic therapies have lower risk of hypoglycemia and should be preferred in treatment of patients with high risk of hypoglycemia. However, education of the patients with diabetes is the most important in prevention of hypoglycemia in patients with diabetes.

hypoglycemia ; glycemic control ; prevention

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