title: Hypoglycemia observed during continuous glucose monitoring in patients with type 2 diabetes mellitus treated by subcutaneous insulin injection.
abstract: BACKGROUND
  The relationship between hypoglycemia and the dose of insulin used in patients with type 2 diabetes mellitus was investigated by continuous glucose monitoring (CGM).
  
  
  METHODS
  In total, 83 CGM studies were performed in 70 outpatients with type 2 diabetes receiving treatment by subcutaneous insulin injection.
  
  
  RESULTS
  The total dose of insulin, bolus insulin dose, and basal insulin dose used in the subjects were 32±18 units, 19±13 units, and 13±8 units, respectively. The proportion of time in the hypoglycemic range (blood glucose<3.9 mmol/L) during CGM was positively correlated with the bolus insulin ratio (bolus/total insulin dose, r=0.22, P=0.04), although it was not associated with the total dose of insulin or the hemoglobin A1c (HbA1c) level. It was negatively correlated with the mean blood glucose (r=-0.38, P<0.01), whereas it was not associated with the SD or the mean amplitude of glycemic excursions (MAGE). The proportion of time in the hypoglycemic range was significantly greater in the subjects with a bolus insulin ratio of ≥0.6 (3.2±4.4%, n=42) than a ratio of <0.6 (1.2±3.0%, n=41), although the HbA1c level, total dose of insulin, mean blood glucose, SD, and MAGE were not significantly different between the two groups.
  
  
  CONCLUSIONS
  An excessive dose of bolus insulin might increase the duration of hypoglycemia, independently from the HbA1c levels, in patients with type 2 diabetes mellitus receiving subcutaneous insulin injection.
authors.affiliation: Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Edogawa-ku, Tokyo, Japan. ito@edogawa.or.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ito
authors.forename: Mariko
authors.initials: M
authors.lastname: Abe
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shinozaki
authors.forename: Koshiro
authors.initials: K
authors.lastname: Oshikiri
authors.forename: Hitomi
authors.initials: H
authors.lastname: Yamashita
authors.forename: Mina
authors.initials: M
authors.lastname: Nakashima
authors.forename: Akifusa
authors.initials: A
authors.lastname: Takaki
authors.forename: Chizuko
authors.initials: C
authors.lastname: Yukawa
authors.forename: Masahide
authors.initials: M
authors.lastname: Furusho
authors.forename: Shinichi
authors.initials: S
authors.lastname: Antoku
authors.forename: Mizuo
authors.initials: M
authors.lastname: Mifune
authors.forename: Michiko
authors.initials: M
authors.lastname: Togane
mesh_terms: D000368:Aged; D061265:Biphasic Insulins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000378:metabolism*; D004305:Dose-Response Relationship, Drug; D045604:Extracellular Fluid / Q000378:metabolism*; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D049528:Insulin, Long-Acting / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D061386:Insulin, Regular, Human / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D061266:Insulin, Short-Acting / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D061265:Biphasic Insulins; D005947:Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D061386:Insulin, Regular, Human; D061266:Insulin, Short-Acting; D011994:Recombinant Proteins; C517652:hemoglobin A1c protein, human