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Hypoglycemia

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Diabetes and the Brain

Part of the book series: Contemporary Diabetes ((CDI))

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Abstract

Hypoglycemia is a common side-effect of insulin therapy for diabetes and is the major factor that limits the maintenance of strict glycemic control. It can be caused by too much insulin, insufficient carbohydrate, or strenuous exercise.

The brain depends on a continuous supply of glucose and rapidly malfunctions if deprived. Failure to reverse the falling blood glucose allows coma to supervene. Several mechanisms have evolved to protect the brain from neuroglycopenia. Counterregulatory hormones, glucagon and epinephrine (adrenaline), are secreted while sympathoadrenal activation generates autonomic warning symptoms along with those associated with cognitive dysfunction. Responses to hypoglycemia occur at different blood glucose thresholds; they can be modified by strict glycemic control and recurrent exposure to hypoglycemia.

In type 1 diabetes the annual prevalence of severe hypoglycemia (requiring help for recovery) is 30–40% while the annual incidence varies depending on the duration of diabetes. In insulin-treated type 2 diabetes, the frequency is lower but increases with duration of insulin therapy. Nocturnal hypoglycemia is common with all insulin regimens. Severe episodes are associated with serious morbidity, causing coma, seizures, injuries, and accidents. Recurrent hypoglycemia can induce acquired syndromes, which include counterregulatory hormonal deficiencies and impaired awareness of hypoglycemia, which increase the risk of severe hypoglycemia.

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Authors and Affiliations

  1. Diabetes Department, EH16 4SA, Edinburgh, UK

    Brian M. Frier BSc (Hons), MD, FRCP (Edin), FRCP (Glas)

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  1. Brian M. Frier BSc (Hons), MD, FRCP (Edin), FRCP (Glas)
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Correspondence to Brian M. Frier BSc (Hons), MD, FRCP (Edin), FRCP (Glas) .

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Editors and Affiliations

  1. Dept. Neurology, University Medical Center Utrecht, Utrecht, 3508 GA, Netherlands

    Geert Jan Biessels

  2. Medical Center, Columbia University, West 168th St. 622, New York, 10032, U.S.A.

    Jose A. Luchsinger

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© 2009 Humana Press, a part of Springer Science+Business Media, LLC

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Frier, B.M. (2009). Hypoglycemia. In: Biessels, G., Luchsinger, J. (eds) Diabetes and the Brain. Contemporary Diabetes. Humana Press. https://doi.org/10.1007/978-1-60327-850-8_6

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  • DOI: https://doi.org/10.1007/978-1-60327-850-8_6

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