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Iatrogenic hypoglycemia is the limiting factor in glycemic management
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American Association of Clinical Endocrinologists 17th Annual Meeting & Clinical Congress
Better methods such as those that provide glucose regulated insulin replacement or secretion are needed to maintain euglycemia and eliminate hypoglycemia from the lives of patients affected by diabetes, Philip E. Cryer, MD, said at the American Association of Clinical Endocrinologists 17th Annual Meeting & Clinical Congress.
“In the battle for glucose control, it’s important to recognize that there is a delicate balancing act being performed,” he said. “Failure to respect that could result in recurrent hypoglycemia.”
Cryer, the Irene E. and Michael M. Karl professor of endocrinology and metabolism at Washington University School of Medicine, St Louis, examined the mechanisms of iatrogenic hypoglycemia and examined ways to minimize risk.
Consider multiple factors
Iatrogenic hypoglycemia is typically the result of the interplay of relative or absolute therapeutic insulin excess and compromised physiological and behavioral defenses against decreasing glucose concentrations, according to Cryer, who is also an Endocrine Today Editorial Board member. It is known to be the cause of recurrent morbidity in patients with type 1 and type 2 diabetes, and sometimes results in mortality.
He discussed the concept of hypoglycemia-associated autonomic failure, which is reversible in most patients. As little as two to three weeks of scrupulous avoidance of iatrogenic hypoglycemia reversed hypoglycemia unawareness and improved the reduced epinephrine component of defective glucose counter-regulation in most of the affected patients, according to results from three independent laboratories.
“By practicing hypoglycemia risk reduction, addressing the issue, applying the principles of aggressive glycemic therapy and considering both the conventional risk factors and those indicative of hypoglycemia-associated autonomic failure, it is possible to both improve glycemic control and reduce the risk of hypoglycemia,” he said.
Cryer told Endocrine Today that the most important message is that “hypoglycemia is the limiting factor in the glycemic management of diabetes.”
“We have to look beyond the traditional risk factors for hypoglycemia,” he said. “I have no intent to dissuade people from glycemic control, but we need to acknowledge that there are issues with hypoglycemia and deal with it accordingly.” – by Tara Grassia
For more information:
- Cryer PE. Hypoglycemia: the limiting factor in the glycemic management of diabetes. Presented at: the American Association of Clinical Endocrinologists 17th Annual Meeting & Clinical Congress; May 14-18, 2008; Orlando, Fla.