For diabetics, strict control of blood glucose can significantly reduce the risk of developing and progressing diabetic complications. However, too tight blood sugar control can easily lead to hypoglycemia. Hypoglycemia not only affects the health of patients, but also affects their quality of life, and severe hypoglycemia can cause disability and death.
Hypoglycemia may present with both symptomatic hypoglycemia and asymptomatic hypoglycemia. The consequences of asymptomatic hypoglycemia are often more severe than those of symptomatic hypoglycemia. Previous studies have shown that nearly 1 in 2 patients with long-term diabetes experience asymptomatic hypoglycemia, which leads to severe hypoglycemia.
How much blood sugar is hypoglycemic in diabetics?
Hypoglycemia refers to the clinical symptoms of ≤ 3.9 mmol/L in the human blood glucose level, with or without hypoglycemia.
In 2005, the American Diabetes Association redefined and classified hypoglycemia, defining ≤ 3.9 mmol/L as asymptomatic hypoglycemia without symptoms of hypoglycemia.
Is asymptomatic hypoglycemia harmful?
Hypoglycemia is one of the common complications of diabetic patients, with an acute onset and great harm to the body. When blood glucose levels are lowered, it leads to brain dysfunction, with the cerebral cortex being affected first, followed by damage to the basal ganglia, hypothalamus, and brainstem. Cerebrovascular spasm, cognitive dysfunction, seizures, coma, and even death may occur clinically.
In addition, repeated episodes of hypoglycemia can accelerate the lesions of large blood vessels and microvascular vessels, causing wounds to be difficult to heal, retinopathy, etc., causing a heavy economic and psychological burden on patients and their families.
It has been reported in the literature that about 25% of diabetic hypoglycemia is asymptomatic hypoglycemia. Asymptomatic hypoglycemia is more dangerous than symptomatic hypoglycemia, because it is not easy to detect, often leading to untimely treatment and serious consequences.
If it occurs at night, the situation is even more dangerous, because the patient's condition cannot be detected in time, resulting in untimely rescue, which may lead to death.
Therefore, once a patient is found to have hypoglycemia, even if there are no related symptoms, it needs to be treated in time. However, many times asymptomatic hypoglycemia is difficult to detect, and identifying high-risk groups and carrying out targeted prevention is the key.
Which diabetes are more likely to develop asymptomatic hypoglycemia?
Patients with type 1 diabetes arelet β have poor cell function and need insulin therapy, and often have glucose regulatory dysfunction in the body;
Patients with type 2 diabetes with significant islet cell dysfunction also have glucose-raising regulatory deficiencies, so both are prone to hypoglycemia, which in turn leads to asymptomatic hypoglycemia.
These factors may contribute to asymptomatic hypoglycemia:
1. Age
With age, the elderly have a greater tolerance to hypoglycemia, hypoglycemia antagonism regulates hormone secretion disorders and adrenal β receptor excitability gradually decreases, liver and kidney function gradually weakens, drug metabolism is slow, easy to accumulate in the body, these factors can induce hypoglycemia.
2. Course of the disease
Metabolic disorders caused by long-term diseases cause the accumulation and exudation of metabolic substances in nerve fibers, sympathetic fiber edema or swelling, and decreased catecholamine secretion, which reduces the body's response to hypoglycemia caused by insulin;
Patients with a longer course of disease are often associated with chronic complications of diabetes, not only kidney complications are prone to hypoglycemia, but neuropathy leads to adrenal response defects that increase the incidence of asymptomatic hypoglycemia.
3. Islet function
Patients with poor islet function are generally defective in the response of glucagon to hypoglycemia, and different degrees of autonomic neuropathy make epinephrine unresponsive to hypoglycemia.
4. Blood sugar control
The occurrence of asymptomatic hypoglycemia is related to the strict control of blood glucose, the lower the glycosylated hemoglobin, the lower the epinephrine secretion, which may be related to the change in the threshold of blood glucose recognition by the glycemic regulation center of the central nervous system, long-term hyperglycemia can improve the ability of the center to recognize blood glucose, and repeated hypoglycemia can lead to a decrease in the center's ability to recognize blood glucose, thereby inhibiting the activity of the autonomic nervous system.
5. Repeated hypoglycemia
Patients with diabetes mellitus may recur hypoglycemia during hypoglycemic therapy, and the response of the central nervous-mediated sympathetic adrenal system (sympathetic and adrenal medulla) to hypoglycemia decreases, resulting in a defective response of epinephrine to hypoglycemic stimulation.
After repeated hypoglycemia, a downward adjustment of the hypoglycemic threshold is caused. After multiple episodes of hypoglycemia, there are no more symptoms of hypoglycemia when hypoglycemia recurs.
6. Sleep
Adrenaline responds less to hypoglycemia during sleep than to non-sleep, and the response to autonomic symptoms during sleep is slow, making asymptomatic hypoglycemia predisposed to nighttime sleep.
7. Exercise
A large amount of exercise can reduce the patient's sympathetic-adrenal medullary system response to hypoglycemia. In the case of existing glucose modulation disorders and defects in the sympathetic adrenal medullary response, a large amount of exercise may lead to asymptomatic hypoglycemia in patients.
How to prevent asymptomatic hypoglycemia?
1. Avoid low blood sugar control and frequent occurrence of hypoglycemia.
2. Improving hypoglycemic therapy can significantly reduce the occurrence of hypoglycemia.
There is evidence that insulin pump therapy and new insulin preparations such as insulin analogues (including long-acting, rapid-acting and mixed preparations) can significantly reduce the occurrence of hypoglycemia, and oral hypoglycemic drugs such as naglilinide and repaglinide can also significantly reduce the occurrence of hypoglycemia.
3. Pay attention to factors such as sleep, exercise, diet, and alcohol consumption.
4. For diabetic patients with hypoglycemia tendencies, hypoglycemic treatment should vary from person to person, and for patients who cannot cooperate with treatment and self-monitoring, blood glucose control standards should be appropriately relaxed.
5. Strengthen dietary guidance for diabetics
Diabetics should eat on time and eat in time after taking hypoglycemic drugs to avoid asymptomatic hypoglycemia. Monitor blood glucose in a timely manner when you have symptoms such as poor appetite and diarrhea.
6. Pay attention to high-risk groups
For example, for elderly patients, pregnant women, newborns, patients with repeated hypoglycemic symptoms at night, etc., strengthen blood glucose monitoring, if the blood glucose ≤ 3.9 mmol/L, regardless of whether hypoglycemic symptoms occur or not, timely interventions should be taken.
Expansion: Treatment of hypoglycemia
We all know that sugary foods should be supplemented when blood sugar is low, but many diabetics will choose staple foods such as steamed buns and biscuits to alleviate symptoms, although this cannot be said to be wrong, but it is not the most appropriate choice.
Because the treatment of hypoglycemia requires a race against the clock, you can eat 15 to 20 g sugar cubes, 150 to 200 mL of juice, a large spoonful of honey and other "simple sugar" foods, because these foods can be quickly absorbed into the bloodstream by the intestine, thereby quickly alleviating the symptoms of hypoglycemia. Starchy foods such as steamed buns are "polysaccharides", which need to be gradually metabolized and decomposed into simple sugars in the body before they can be absorbed by the human body, and the speed of correcting hypoglycemia is relatively slow.
In addition, diabetics taking α-glycosidase inhibitors must supplement monosaccharides (such as glucose, sucrose) when hypoglycemia occurs, because α-glycosidase inhibitors can delay the absorption of macromolecular carbohydrates (such as steamed buns) so that they cannot quickly raise blood sugar.
Patients with impaired consciousness are given intravenously with 50% glucose solution 20 to 40 mL, or intramuscular glucagon 0.5 to 1.0 mg.
Monitor blood glucose every 15 minutes after treatment accordingly.
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This article was first published on Lilac Garden's professional platform: Endocrine Time
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