Hypoglycemia unawareness

The recurrence of hypoglycemic episodes leads to attenuation of the normal counter-regulatory mechanisms that are controlled by the hypothalamus, which results in hypoglycemia unawareness (HU). In this case report, we described for the first time the differential expression of TNF-α, IL-1β, IL-6, and IFN-γ in a blood sample that was taken from a 27-year-old patient with type 1 diabetes mellitus (T1DM) who was diagnosed with HU. The anti-diabetic regimen is currently based on insulin injection, but the patient is planning to start the use of an insulin pump to have better control of glucose levels. Our results showed a trend toward an increase in the expression of IL-1β, IL-6, and IFN-γ in T1DM patient with HU. However, the mRNA level of TNF-α showed a significant decrease. These observations suggest that systemic inflammation could be an underlying cause of HU.

Download Full-text

Hypoglycemia Unawareness in IDDM

Diabetes Care ◽

10.2337/diacare.17.12.1397 ◽

1994 ◽

Vol 17 (12) ◽

pp. 1397-1403 ◽

Cited By ~ 81

Author(s):

M. Mokan ◽

A. Mitrakou ◽

T. Veneman ◽

C. Ryan ◽

M. Korytkowski ◽

...

Keyword(s):

Hypoglycemia Unawareness

Download Full-text

Hypoglycemia-Associated Autonomic Failure in Type 1 Diabetes: Beyond Hypoglycemia Unawareness

Clinical Diabetes ◽

10.2337/cd21-0100 ◽

2021 ◽

pp. cd210100

Author(s):

Aristeidis Giannakopoulos ◽

Alexandra Efthymiadou ◽

Anastasia Chrysanthakopoulou ◽

Dionisios Chrysis

Keyword(s):

Type 1 Diabetes ◽

Autonomic Failure ◽

Hypoglycemia Unawareness

Download Full-text

„Hypoglycemia unawareness“

Kompendium Diabetologie ◽

10.1007/978-3-642-58588-3_14 ◽

1999 ◽

pp. 605-623

Author(s):

M. S. Klevesath ◽

B. Isermann ◽

P. P. Nawroth

Keyword(s):

Hypoglycemia Unawareness

Download Full-text

Dead in bed syndrome: Mystery and fear

Journal of Social Health and Diabetes ◽

10.4103/2321-0656.140880 ◽

2015 ◽

Vol 03 (01) ◽

pp. 022-025

Author(s):

Resham Poudel ◽

Nisha Kafle ◽

Bipin Belbase ◽

Pradip Kafle

Keyword(s):

Positive Family History ◽

Glucose Monitoring ◽

Monitoring Device ◽

Hypoglycemia Unawareness ◽

Nocturnal Hypoglycemia ◽

Dead In Bed Syndrome ◽

Fatal Arrhythmia ◽

Plausible Mechanism ◽

Vulnerable Individual

AbstractDead in bed (DIB) syndrome is a poorly understood cause of sudden and mysterious death in young people with type 1 diabetes on insulin therapy. Severe nocturnal hypoglycemia with unawareness is the most plausible mechanism which precipitates fatal arrhythmia in the vulnerable individual. Avoiding recurrent hypoglycemic episodes; screening for proarrhythmic condition in high-risk people with positive family history; and using real-time continuous glucose monitoring device in those with nighttime hypoglycemia and hypoglycemia unawareness can help to reduce the incidence of this deadly condition.

Download Full-text

A Systematic Review of Neuroprotective Strategies in the Management of Hypoglycemia

International Journal of Molecular Sciences ◽

10.3390/ijms20030550 ◽

2019 ◽

Vol 20 (3) ◽

pp. 550

Author(s):

Marius Nistor ◽

Martin Schmidt ◽

Isabel Graul ◽

Florian Rakers ◽

René Schiffner

Keyword(s):

Systematic Review ◽

Animal Experiments ◽

Risk Of Bias ◽

Cerebral Damage ◽

Hypoglycemia Unawareness ◽

Prisma Statement ◽

Neuroprotective Strategies ◽

Review Protocol ◽

The Individual ◽

Prevalence Of Diabetes Mellitus

Severe hypogylcemia has been found to induce cerebral damage. While a number of illnesses can lead to hypoglycemic episodes, antidiabetic medications prescribed for glycemic control are a common cause. Considering the rising prevalence of diabetes mellitus in the population, we investigated neuroprotective strategies during hypoglycemia in the form of a systematic review in adherence to the PRISMA statement. A review protocol was registered in the PROSPERO database. A systematic literature search of PubMed, Web of Science, and CENTRAL was performed in September 2018. Based on a predefined inclusion protocol, results were screened and evaluated by two researchers. Both animal experiments and human studies were included, and their risk of bias was assessed with SYRCLE’s and the Cochrane risk of bias tools, respectively. Of a total of 16,230 results, 145 were assessed in full-text form: 27 articles adhered to the inclusion criteria and were qualitatively analyzed. The retrieved neuroprotective strategies could be categorized into three subsets: (1) Energy substitution, (2) hypoglycemia unawareness, and (3) other neuroprotective strategies. While on a study level, the individual results appeared promising, more research is required to investigate not only specific neuroprotective strategies against hypoglycemic cerebral damage, but also its underlying pathophysiological mechanisms.

Download Full-text

Comment on Harlan. Islet Transplantation for Hypoglycemia Unawareness/Severe Hypoglycemia: Caveat Emptor. Diabetes Care 2016;39:1072–1074

Diabetes Care ◽

10.2337/dc16-2691 ◽

2017 ◽

Vol 40 (8) ◽

pp. e111-e112 ◽

Cited By ~ 1

Author(s):

Bernhard J. Hering ◽

Nancy D. Bridges ◽

Thomas L. Eggerman ◽

Camillo Ricordi

Keyword(s):

Islet Transplantation ◽

Diabetes Care ◽

Severe Hypoglycemia ◽

Caveat Emptor ◽

Hypoglycemia Unawareness

Download Full-text

Nonislet Cell Tumor Hypoglycemia

Case Reports in Endocrinology ◽

10.1155/2013/308086 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Johnson Thomas ◽

Salini C. Kumar

Keyword(s):

Glucose Utilization ◽

Cell Tumor ◽

Gi Tract ◽

Normal Range ◽

Mesenchymal Tumors ◽

Hypoglycemia Unawareness ◽

Factor Ii ◽

Carcinoma Of Esophagus ◽

Poorly Differentiated ◽

Tumor Hypoglycemia

Nonislet cell tumor hypoglycemia (NICTH) is a rare cause of hypoglycemia. It is characterized by increased glucose utilization by tissues mediated by a tumor resulting in hypoglycemia. NICTH is usually seen in large mesenchymal tumors including tumors involving the GI tract. Here we will discuss a case, its pathophysiology, and recent advances in the management of NICTH. Our patient was diagnosed with poorly differentiated squamous cell carcinoma of esophagus. He continued to be hypoglycemic even after starting continuous tube feeds and D5W. General workup for hypoglycemia was negative and insulin-like growth factor II (IGF II) was in the normal range. Hypoglycemia secondary to “big” IGF II was considered, and patient was started on steroids. His hypoglycemia resolved within a day of treatment with steroids. Initially patient had hypoglycemia unawareness, which he regained after maintaining euglycemia for 48 hours.

Download Full-text

Hypoglycemia-associated autonomic failure in diabetes

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.2001.281.6.e1115 ◽

2001 ◽

Vol 281 (6) ◽

pp. E1115-E1121 ◽

Cited By ~ 75

Author(s):

Philip E. Cryer

Keyword(s):

Risk Factors ◽

Autonomic Failure ◽

Clinical Risk Factors ◽

Limiting Factor ◽

Vicious Cycle ◽

Hypoglycemia Unawareness ◽

Glucose Levels ◽

Glycemic Management ◽

Recurrent Hypoglycemia ◽

Insight Into

Hypoglycemia is the limiting factor in the glycemic management of diabetes. The concept of hypoglycemia-associated autonomic failure (HAAF) in diabetes posits that recent antecedent iatrogenic hypoglycemia causes both defective glucose counterregulation (by reducing the epinephrine response to falling glucose levels in the setting of an absent glucagon response) and hypoglycemia unawareness (by reducing the autonomic and the resulting neurogenic symptom responses) and thus a vicious cycle of recurrent hypoglycemia. Perhaps the most compelling support for HAAF is the finding that as little as 2–3 wk of scrupulous avoidance of hypoglycemia reverses hypoglycemia unawareness and improves the reduced epinephrine component of defective glucose counterregulation in most affected individuals. Insight into this pathophysiology has led to a broader view of the clinical risk factors for hypoglycemia to include indexes of compromised glucose counterregulation and provided a framework for the study of the mechanisms of iatrogenic hypoglycemia and, ultimately, its elimination from the lives of people with diabetes.

Download Full-text