Complications
Recurrent episodes of hypoglycaemia may lead to lowering of the blood glucose at which stress responses (i.e., glucagon secretion, stimulation of the sympathetic nervous system, and release of catecholamine, growth hormone, and cortisol) are triggered.[10][43][116] Alteration of these mechanisms means that the normal warning symptoms of hypoglycaemia occur at progressively lower blood glucose levels, which increases the risk of severe hypoglycaemia.[7][10][33][59] This is known as impaired awareness of hypoglycaemia or hypoglycaemia-associated autonomic failure.[7][10]
If a patient has impaired awareness of hypoglycaemia, consider short-term relaxation of glycaemic targets; several weeks of avoidance of hypoglycaemia has been shown to improve counter-regulatory hormone response and impaired awareness of hypoglycaemia.[1][3]
Hypoglycaemia can negatively affect a patient's quality of life and well-being in several aspects, including sleep disturbances; loss of fitness to drive; limited work opportunities and employment; restricted exercise, recreational activities, and travel; and negative impacts on family relationships.[116][117]
Episodes of hypoglycaemia increase the risk of cognitive impairment, including dementia.[57][123] A systematic review and meta-analysis of 1.4 million patients showed that episodes of hypoglycaemia were associated with a statistically significant increase in the risk of dementia in patients with diabetes compared to those without episodes of hypoglycaemia (hazard ratio [HR] 1.44, 95% CI 1.26 to 1.65).[57]
Hypoglycaemia stimulates the adrenergic response and fall of plasma potassium, which can lead to prolongation of QTc interval, tachycardia, fibrillation, and sudden cardiac death in an acute setting.[116][117]
There is also evidence that suggests hypoglycaemia can lead to long-term cardiovascular complications such as myocardial infarction and stroke.[118][119]
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