[Hypoglycemia as a limiting factor in the management of type 1 diabetes].
Type 1 diabetic patients frequently present hypoglycemic episodes during their insulinotherapy, which, besides the discomfort and constrains does not allow the ideal glycemic control. Further, hypoglycemic events lead to the deficiency of the counter-regulation mechanisms in the subsequent episode, with a decrease in the release of epinephrine and the symptoms of warming, with great risk of severe hypoglycemia. The occurrence of hypoglycemia during some risky activities, specially driving, could result in accidents with the patient and /or third parts including property damage, stressing here the need to advise diabetics against having the necessary caution while driving. Generally the connective recovery is total after correcting a hypoglycemic coma. However when these episodes are repetitive, particularly in children, they could result in definitive cognitive disturbances. Hypoglycemic events without a warning signal (hypoglycemic unawareness) are difficult to reverse, thus it is necessary to prevent their occurrence, adjusting the treatment with glycemic targets, using continuous glucose monitoring at home and teaching them how to have an early recognition of hypoglycemia.
Nery
Márcia
M
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. marcianery@hcnet.usp.br
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000139:chemically induced; D015190:Blood Glucose Self-Monitoring; D001930:Brain Injuries / Q000139:chemically induced; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D005934:Glucagon / Q000172:deficiency / Q000378:metabolism / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007328:Insulin / Q000009:adverse effects* / Q000378:metabolism; D000078790:Insulin Secretion; D008875:Middle Aged; D055815:Young Adult
D005765:Gastrointestinal Agents; D007004:Hypoglycemic Agents; D007328:Insulin; D005934:Glucagon