Hypoglycaemia is said to exist if the level of glucose in the blood falls below 3.3 mmol/1. However, Diabetes UK has recommended that 4 mmol/1 should be the recognized basal level below which there is a risk or likelihood of hypoglycaemia. This has become the 'working level' adopted by diabetes clinics and upon which their advice to patients is based.
Many people think that hypoglycaemia is a feature of diabetes, but it is in fact a side-effect of certain forms of treatment for the condition, notably insulin and sulphonylurea therapy. Hypoglycaemia is more common in people with Type 1 diabetes, 10 per cent of whom experience at least one serious episode each year, requiring hospital treatment, in addition to less severe attacks. The good news is that these episodes are almost always successfully treated and the person is usually quickly restored to normal health.
In spite of this hypoglycaemia is, quite understandably, the most feared side-effect of insulin treatment. Unfortunately, as we have seen, the incidence of severe 'hypos' increases with tight glycaemic control in Type 1 diabetes. This is the main limiting factor in intensive insulin therapy and achieving good glycaemic control. Intensive treatment is highly desirable since it reduces the risks of diabetic complications, but the fear of hypoglycaemia makes many people with diabetes hesitate about intensive therapy.
People with Type 2 diabetes who are being treated with sulphonylureas and/or insulin may also experience hypoglycaemia, but for most the attacks are less frequent and not so severe. However, very severe episodes of hypoglycaemia are a rare but recognized hazard of sulphonylurea treatment, especially in elderly people. These attacks may prove fatal in extremely unusual circumstances. When this has occurred, it has usually been connected with one of the longer-acting sulphonylureas, although any one of this group of drugs has the potential to cause hypoglycaemia.
This risk means that longer-acting sulphonylureas are not normally prescribed for elderly people. It is thought that the action of sulphonylureas in suppressing glucose production by the liver is the main reason why these drugs may cause hypoglycaemia. Elderly people appear to be particularly susceptible to this effect. Other high-risk situations which may exacerbate the hypoglycaemic potential of sulphonylureas, are interactions with other drugs, including alcohol, and metabolic stresses caused by periods of infection or illness.
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