Hypoglycemia
One of the first tenants of medical practice is to “do no harm.” Treating patients with diabetes medications, however, carries a significant risk of inflicting harm and injury by causing hypoglycemia. Were it not for this potential side effect, diabetes treatment would be considerably easier.
Many treatments frequently involve augmenting insulin effects directly (injected insulin) or indirectly (increasing insulin release from the pancreatic β-cells, increasing insulin sensitivity, or inhibiting hepatic glucose production). When endogenous insulin levels are altered, hypoglycemia is always a potential side effect to therapy and, in fact, is one of the most common adverse reactions in diabetes treatment.
It is important, therefore, to be able to identify, treat, and also avoid mild and severe hypoglycemic complications of diabetes therapy. Such complications may be life-threatening and resistant to initial therapy; therefore, it is important for physicians who prescribe potent diabetes medications such as insulin to be able to identify causes of such adverse reactions and arrest them before they progress.
Hypoglycemia Mechanisms
Hypoglycemia is in many ways the Achilles' heel of diabetes treatment. Medical authors have astutely noted that hypoglycemia is “the limiting factor” in the treatment of diabetes.1-3 Reduction of glucose levels in patients with type 1 or type 2 diabetes has been shown to decrease the risks of kidney, nerve, and retinal injury. Lower glucose levels are also associated with reduction in cardiovascular disease in patients with type 1 diabetes. Were it not for the development of hypoglycemia, every patient with diabetes could conceivably control their diabetes with greater ease using high doses of oral medications or insulin.
Such is not the case, however. Treatment of diabetes, especially intensive treatment, brings the risk of lowering blood glucose levels excessively and causing hypoglycemia. Severe hypoglycemia is usually considered to be an episode of hypoglycemia in …
