HIPOGLICEMIA: UNAWARE COMPLICATION OF DIABETES MELLITUS

YENI MARIA CHRISTINA

Muhammadiyah University of Jember
faizardirama@gmail.com

ABSTRACT

Hypoglycemia in diabetic patients occurs when an imbalance between insulin/ hypoglycemic

agent’s intake and bodyphysiological need exists. Whe the patient come to Emergency Room,
this is a true medical emergency which requires prompt recognition and treatment to prevent
organ and brain damage. Although occuring more frequently in diabetes type 1 diabetes,
hypoglicemia also clinically important in type 2 diabetes. In type 2 diabetes, progressive insulin
deficiency, longer duration of diabetes, and tight glycemic control increase the risk of
hypoglicemia as much as type 1 diabetes. Delay in treating hypoglicemia can cause severe
morbidity and even death. To prevent or reduce the risk of hypoglycemia, it is important that the
patient understands and agrees to adhere to all aspects of the treatment plan in terms of both
medication and lifestyle modification. Educating the patient and his/her family members, along
with self-monitoring of blood glucose (SMBG) are of paramount importance to prevent
hypoglycemic episodes.
Keyword: Diabetes; Hypoglicemia; Treatment options; Health education

Background aged 20–79 years was 6.4% (285 million) in

Diabetes Mellitus is achronic disease that
require continous medical care and patient
self management education to prevent acute
complications and reduce the risk
longterm complications (Shafiee, Mohajeri-
Tehrani, Pajouhi, & Larijani, 2012). In
Diabetes Mellitus, high blood sugar level is
caused by defect in insulin secretion, insulin
action, or both. The World Health
Organization (WHO) is warning that the
number of people with diabetes is rapidly
increasing. Shaw et al, estimated that the
world prevalence of diabetes among adults
2010, and will increase to 7.7% (439 million)
by 2030. Predictions compiled by Dr Hilary
King of the WHO before 1999 showed that
of this figure will rise to 300 million by the year
2025, and more than 150 million will be in
Asia. The prevalence of diabetes mellitus in
productive age urban Indonesians was 4.6%,
consisting of 1.1% previously diagnosed
diabetes mellitus and 3.5% undiagnosed
diabetes mellitus. Diabetes mellitus affected
more women than men, which increased with
age, was higher among the high
socioeconomic group and increased with
increasing body mass index. The prevalence
of diabetes mellitus was higher in centrally leading to renal failure; peripheral
obese people. Hypertension was highly neuropathy with risk of foot ulcers,
related with diabetes mellitus occurrence. amputations, and Charcot joints; and
The prevalence of previously diagnosed autonomic neuropathy causing
diabetes mellitus with overweight or obese gastrointestinal, genitourinary, and
was 68.4%, with central obesity 41.7%, with cardiovascular symptoms and sexual
hypertension 41.4% and with dyslipidemia dysfunction. Patients with diabetes have an
more than 50%. The prevalence of increased incidence of atherosclerotic
undiagnosed diabetes respondents with cardiovascular, peripheral arterial, and
overweight or obese was 68,7%, with central cerebrovascular disease. Hypertension and
obesity 43.8%, with hypertension 49.4% and abnormalities of lipoprotein metabolism are
with dyslipidemia more than 50% (Mihardja, often found in people with diabetes. Short-
Soetrisno, & Soegondo, 2014). term complications of diabetes include
diabetes ketoacidosis (DKA),
Several pathogenic processes are involved
hyperglycaemic state (HHS) and
in the development of diabetes. These range
hypoglicemia. Hypoglycemia can be defined
from autoimmune destruction of the β-cells of
in several ways: by plasma glucose values
the pancreas with consequent insulin
(biochemical definition), by symptoms (type
deficiency to abnormalities that result in
and severity), and by time of day in which it
resistance to insulin action. The basis of the
occurs (daytime or nocturnal). The ADA
abnormalities in carbohydrate, fat, and
standard of 70 mg/dL (3.9 mmol/L) is an alert
protein metabolism in diabetes is deficient
value, intended to provide a margin of error
action of insulin on target tissues. Deficient
for the limited accuracy of glucose monitoring
insulin action results from inadequate insulin
devices at lower glucose level (Morales &
secretion and/or diminished tissue
Schneider, 2014). A starting point is to
responses to insulin at one or more points in
assess the health literacy of patients and
the complex pathways of hormone action.
theirsupport structure/resources at home. It
Impairment of insulin secretion and defects
is essential to determine whether they are
in insulin action frequently coexist in the
able to administer medications correctly,
same patient, and it is often unclear which
perform self-monitoring of blood glucose,
abnormality, if either alone, is the primary
adjust insulin doses, and know when to ask
cause of the hyperglycemia (American
for assistance. In one study, even after an
Diabetes Association, 2010). Long-term
educational program, people often struggled
complications of diabetes include retinopathy
to adhere to guidelines for self-treatment of
with potential loss of vision; nephropathy
hypoglycemia. By being aware of the sign patients experiencing severe hypoglycemia
and symptoms of hypoglicemia, more people in comparison to those not experiencing
who consuming diabetic theraphy can avoid severe hypoglycemia Repeated episodes of
the danger of hypoglicemia. Furthermore, hypoglycemia can lead to impairment of the
this article aimed the health care counter-regulatory system with the potential
professionals assess patient’s need for for development of hypoglycemia
support during patient visits and follow-up to unawareness. (Kalra et al., 2013).
ensure that the required support is provided Unfortunately, the symptoms experienced
especially by the family member. Given that are inconsistent between individuals, which
the patients themselves are responsible on a complicates our efforts in identifying
daily basis for regulating the blood sugar hypoglycemia and in counseling patients
levels (self-monitoring of blood glucose, who experience these symptoms.
SMBG), encouragement and family support
Causes and risk factor of hypoglicemia
are main aspects of the educational program.
Antidiabetic therapies, individually and used
in combination, vary substantially in their risk
Metodhe of hypoglycemia. In general, hypoglycemia in
diabetic patients occurs when an imbalance
1. Protocol based approach
between insulin/hypoglycemic agent’s intake
2. Databases and search terms were
and body’s physiological need exists. The
prespecified and literature publised
following reasons could account for
between 2010-2017
hypoglycemia in diabetics: Iatrogenic,diet
3. Proquest
changes and infections. Diabetes
Sign and symptoms of hypoglicemia medications including insulin and

.Early adrenergic symptoms are pallor, sulphonylureas are among the most common

diaphoresis, shakiness, hunger, anxiety, causes of hypoglycemia in diabetic subjects.

irritability, headache and dizziness. The The longer-acting sulphonylureas such as

neurologlycopenic signs are confusion, glibenclamide and chlorpropamide are

slurred speech, irrational or uncontrolled associated with more severe hypoglycemia

behavior, disorientation, loss of than the shorter-acting drugs. Occasional

consiousnee, seizures, pupillary episodes of hypoglycemia with Metformin, as

sluggishness and decreased response to the most commonly used anti-diabetic drug,

noxious stimuli. A six-fold increase in deaths are reported when an imbalance between

due to diabetes has been attributed to food intake and dose of Metformin is
presented . Hypoglycemia may also result
from little foods intake or increase in activity
in relation to medication and food intake.
Other causes such as alcohol consumption,
some drugs, stress and infections should
also be considered in diabetic subjects.
Alcohol may contribute to the severity

of hypoglycemia by inhibiting
gluconeogenesis.