Patients should be monitored more closely with changes to insulin dosage, co-administration of other glucose-lowering medications, meal pattern, physical activity, and in patients with renal impairment or hepatic impairment or hypoglycemia unawareness
Increase monitoring with changes to: insulin dose, co-administered glucose lowering medications, meal pattern, physical activity; and in patients with hypoglycemia unawareness
or renal or hepatic impairment
Two pathophysiologic mechanisms contribute to hypoglycemia in diabetes, namely defective glucose counterregulation (impaired response of glucagon) and hypoglycemia unawareness
(absence of neurogenic symptoms).
gt; Hypoglycemia unawareness
(diabetic patients with low blood glucose who do not have any symptoms of low blood sugar and are not aware of the hypoglycemia).
Patients who have hypoglycemia unawareness
and whose episodes do not result in EMS or ED care [were] not counted, nor [were] those who died en route to the ED," they added.
The risk of hypoglycemia and hypoglycemia unawareness
Focusing on the practical implications, we review the endocrinological principles underlying normal glucose homeostasis and the defects in regulation and counterregulation, including hypoglycemia unawareness
, that occur with diabetes.
Islet transplantation improves glucose control and alleviates hypoglycemia unawareness
for those already taking immunosuppressive drugs after a kidney transplant.
Another concern is hypoglycemia unawareness
, which could be exacerbated by intensive insulin therapy during pregnancy.
This limits the eligibility for the procedure to the most advanced cases of diabetes--patients with hypoglycemia unawareness
or those who have frequent up and down blood sugars despite appropriate treatment.
However, other problems can also cause hypoglycemia unawareness
so this does not always indicate nerve damage.
7 The statement recommends CGM particularly for children, adolescents and adults with frequent hypoglycemia or hypoglycemia unawareness
, A1C levels over their target, large variability in glycemic levels, and the need to lower A1C levels without increasing hypoglycemic events, as well as for those who are pregnant or are planning to become pregnant.