Hypoglycaemia in diabetes mellitus

Authors: Peter Novodvorský 1,2
Authors‘ workplace: Metabolické centrum s. r. o., Diabetológia, poruchy látkovej premeny a výživy, Trenčín 1;  Department of Oncology & Metabolism, Medical School, University of Sheffield, United Kingdom 2
Published in: Diab Obez 2019; 19(37): 20-26


Despite recent advances in diabetes management, such as the introduction of new insulin analogues or the use of novel technologies, hypoglycaemia continues to be a common and feared complication of insulin, sulfonylurea and glinide treated diabetes. Hypoglycaemia thus remains a major barrier for improved metabolic control. In a healthy human, blood glucose is regulated within a narrow range by physiological mechanisms preventing both hypo- and hyperglycaemia, but these mechanisms are impaired in people with diabetes. In addition, current modes of insulin delivery and its pharmacokinetics do not mimic the healthy physiology and lead to increased risk of hypoglycaemia. Impaired awareness of hypoglycaemia (IAH) remains a separate and much feared complication of diabetes. The International Hypoglycaemia Study Group have recently published a new classification of hypoglycaemia and recommend glucose concentration of < 3.0 mmol/L (54 mg/dL) to be considered clinically significant hypoglycaemia.

Received 1. 4. 2019

Accepted 24. 4. 2019


hypoglycemia – adrenaline – glucagon – insulin – nocturnal hypo­glycaemia – type 1 diabetes – type 2 diabetes

  1. Seaquist ER, Anderson J, Childs B et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. J Clin Endocrinol Metab 2013; 98(5): 1845–1859. Dostupné z DOI: <http://dx.doi.org/10.1210/jc.2012–4127>.

  2. Cryer PE. Hypoglycemia, functional brain failure, and brain death. J Clin Invest 2007; 117(4): 868–870. Dostupné z DOI: <http://dx.doi.org/10.1172/JCI31669>.

  3. IDF Diabetes Atlas. 8th ed. International Diabetes Federation: Brussells, Belgium 2017. Dostupné z WWW: <http://www.diabetesatlas.org>.

  4. [UK Hypoglycaemia Study Group]. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia 2007; 50(6): 1140–1147. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–007–0599-y>.

  5. Iqbal A, Novodvorsky P, Heller SR. Recent Updates on Type 1 Diabetes Mellitus Management for Clinicians. Diabetes Metab J 2018; 42(1): 3–18. Dostupné z DOI: <http://dx.doi.org/10.4093/dmj.2018.42.1.3>. Erratum in Corrigendum: Table and Text Correction. Recent Updates on Type 1 Diabetes Mellitus Management for Clinicians. [Diabetes Metab J 2018].

  6. Gerstein HC, Miller ME, Byington RP et al. [Action to Control Cardiovascular Risk in Diabetes Study Group]. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358(24): 2545–2559. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0802743>.

  7. Finfer S, Chittock DR, Su SY et al. [NICE-SUGAR Study Investigators]. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009; 360(13): 1283–1297. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0810625>.

  8. Novodvorsky P, Bernjak A, Chow E et al. Diurnal Differences in Risk of Cardiac Arrhythmias During Spontaneous Hypoglycemia in Young People With Type 1 Diabetes. Diabetes Care 2017; 40(5): 655–662. Dostupné z DOI: <http://dx.doi.org/10.2337/dc16–2177>.

  9. Chow E, Bernjak A, Williams S et al. Risk of cardiac arrhythmias during hypoglycemia in patients with type 2 diabetes and cardiovascular risk. Diabetes 2014; 63(5): 1738–1747. Dostupné z DOI: <http://dx.doi.org/10.2337/db13–0468>.

  10. Wright RJ, Newby DE, Stirling D et al. Effects of acute insulin-induced hypoglycemia on indices of inflammation: putative mechanism for aggravating vascular disease in diabetes. Diabetes Care 2010; 33(7): 1591–1597. Dostupné z DOI: <http://dx.doi.org/10.2337/dc10–0013>.

  11. Hutton RA, Mikhailidis D, Dormandy KM et al. Platelet aggregation studies during transient hypoglycaemia: a potential method for evaluating platelet function. J Clin Pathol 1979; 32(5): 434–438.

  12. Iqbal A, Prince LR, Novodvorsky P et al. Effect of Hypoglycemia on Inflammatory Responses and the Response to Low-Dose Endotoxemia in Humans. J Clin Endocrinol Metab 2019; 104(4):1187–1199. Dostupné z DOI: <http://dx.doi.org/10.1210/jc.2018–01168>.

  13. Gogitidze Joy N, Hedrington MS, Briscoe VJ et al. Effects of acute hypoglycemia on inflammatory and pro-atherothrombotic biomarkers in individuals with type 1 diabetes and healthy individuals. Diabetes Care 2010; 33(7): 1529–1535. Dostupné z DOI: <http://dx.doi.org/10.2337/dc09–0354>. Erratum in Diabetes Care 2010; 33(9): 2129.

  14. Joy NG, Tate DB, Younk LM et al. Effects of Acute and Antecedent Hypoglycemia on Endothelial Function and Markers of Atherothrombotic Balance in Healthy Humans. Diabetes 2015; 64(7): 2571–2580. Dostupné z DOI: <http://dx.doi.org/10.2337/db14–1729>.

  15. [International Hypoglycaemia Study Group]. Glucose Concentrations of Less Than 3.0 mmol/L (54 mg/dL) Should Be Reported in Clinical Trials: A Joint Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2017; 40(1): 155–157. Dostupné z DOI: <http://dx.doi.org/10.2337/dc16–2215>.

  16. Jones TW, Porter P, Sherwin RS et al. Decreased epinephrine responses to hypoglycemia during sleep. N Engl J Med 1998; 338(23): 1657–1662. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJM199806043382303>.

  17. Iqbal A, Heller SR. The role of structured education in the management of hypoglycaemia. Diabetologia 2018; 61(4): 751–760. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–017–4334-z>.

  18. Little SA, Leelarathna L, Walkinshaw E et al. Recovery of hypoglycemia awareness in long-standing type 1 diabetes: a multicenter 2 x 2 factorial randomized controlled trial comparing insulin pump with multiple daily injections and continuous with conventional glucose self-monitoring (HypoCOMPaSS). Diabetes Care 2014; 37(8): 2114–2122. Dostupné z DOI: <http://dx.doi.org/10.2337/dc14–0030>.

  19. Choudhary P, Rickels MR, Senior PA et al. Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia. Diabetes Care 2015; 38(6): 1016–1029. Dostupné z DOI: <http://dx.doi.org/10.2337/dc15–0090>.

Diabetology Obesitology
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account