5.3.0.0 Hy­po­glycemia Pre­ven­tion

Hy­po­glycemia pre­vention is a crit­i­cal com­po­nent of di­a­betes man­age­ment. SMBG and, for some pa­tients, CGM are es­sen­tial tools to as­sess ther­a­py and de­tect in­cip­i­ent hy­po­glycemia. Pa­tients should un­der­stand sit­u­a­tions that in­crease their risk of hy­po­glycemia, such as when fast­ing for tests or pro­ce­dures, when meals are de­layed, dur­ing and after the con­sump­tion of al­co­hol, dur­ing and after in­tense ex­er­cise, and dur­ing sleep. Hy­po­glycemia may in­crease the risk of harm to self or oth­ers, such as with driv­ing. Teach­ing peo­ple with di­a­betes to bal­ance in­sulin use and car­bo­hy­drate in­take and ex­er­cise are nec­es­sary, but these strate­gies are not al­ways sufficient for pre­vention.

In type 1 di­a­betes and se­verely in­sulindeficient type 2 di­a­betes, hy­po­glycemia un­aware­ness (or hy­po­glycemia-‍as­so­ci­at­ed au­to­nom­ic fail­ure) can se­verely com­pro­mise strin­gent di­a­betes con­trol and qual­i­ty of life. This syn­drome is char­ac­ter­ized by deficient coun­ter­reg­u­la­to­ry hor­mone re­lease, es­pe­cial­ly in older adults, and a di­min­ished au­to­nom­ic re­sponse, which both are risk fac­tors for, and caused by, hy­po­glycemia. A corol­lary to this “vi­cious cycle” is that sev­er­al weeks of avoid­ance of hy­po­glycemia has been demon­strat­ed to im­prove coun­ter­reg­u­la­tion and hy­po­glycemia aware­ness in many pa­tients (59). Hence, pa­tients with one or more episodes of clin­i­cally significant hy­po­glycemia may benefit from at least short-‍term re­lax­ation of glycemic tar­gets.