Complications
Recurrent episodes of hypoglycemia 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][42][116] Alteration of these mechanisms means that the normal warning symptoms of hypoglycemia occur at progressively lower blood glucose levels, which increases the risk of severe hypoglycemia.[7][10][33] This is known as impaired awareness of hypoglycemia or hypoglycemia-associated autonomic failure.[7][10]
If a patient has impaired awareness of hypoglycemia, consider short-term relaxation of glycemic targets; several weeks of avoidance of hypoglycemia has been shown to improve counterregulatory hormone response and impaired awareness of hypoglycemia.[1][3]
Hypoglycemia 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 hypoglycemia increase the risk of cognitive impairment, including dementia.[56][123] A systematic review and meta-analysis of 1.4 million patients showed that episodes of hypoglycemia were associated with a statistically significant increase in the risk of dementia in patients with diabetes compared to those without episodes of hypoglycemia (hazard ratio [HR] 1.44, 95% CI 1.26 to 1.65).[56]
Hypoglycemia 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 hypoglycemia can lead to long-term cardiovascular complications such as myocardial infarction and stroke.[118][119]
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