Iqbal, A. orcid.org/0000-0002-5648-0539 and Heller, S. orcid.org/0000-0002-2425-9565 (2016) Managing hypoglycaemia. Best Practice & Research Clinical Endocrinology & Metabolism, 30 (3). pp. 413-430. ISSN 1521-690X
Abstract
Intensive glycaemic control reduces the diabetic microvascular disease burden but iatrogenic hypoglycaemia is a major barrier preventing tight glycaemic control because of the limitations of subcutaneous insulin preparations and insulin secretagogues. Severe hypoglycaemia is uncommon early in the disease as robust physiological defences, particularly glucagon and adrenaline release, limit falls in blood glucose whilst associated autonomic symptoms drive patients to take action by ingesting oral carbohydrate. With increasing diabetes duration, glucagon release is progressively impaired and sympatho-adrenal responses are activated at lower glucose levels. Repeated hypoglycaemic episodes contribute to impaired defences, increasing the risk of severe hypoglycaemia in a vicious downward spiral. Managing hypoglycaemia requires a systematic clinical approach with structured insulin self-management training and support of experienced diabetes educators. Judicious use of technologies includes insulin analogues, insulin pump therapy, continuous glucose monitoring, and in a few cases islet cell transplantation. Some individuals require specialist psychological support.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2016 Elsevier. This is an author produced version of a paper subsequently published in Best Practice & Research Clinical Endocrinology & Metabolism. Uploaded in accordance with the publisher's self-archiving policy. Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/) |
Keywords: | hypoglycaemia; counter-regulation; impaired hypoglycaemia awareness; adrenaline; cardiovascular risk |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > The Medical School (Sheffield) > Division of Genomic Medicine (Sheffield) > Department of Oncology and Metabolism (Sheffield) The University of Sheffield > Sheffield Teaching Hospitals |
Funding Information: | Funder Grant number MEDICAL RESEARCH COUNCIL MR/M00371X/1 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 08 Aug 2016 10:43 |
Last Modified: | 11 Oct 2017 02:36 |
Published Version: | http://dx.doi.org/10.1016/j.beem.2016.06.004 |
Status: | Published |
Publisher: | Elsevier |
Refereed: | Yes |
Identification Number: | 10.1016/j.beem.2016.06.004 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:103453 |
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