King's College London School of Medicine, 3.39, Weston Education Centre, Cutcombe Road, Denmark Hill Campus, Weston Education Centre, London SE5 9RJ, UK.
Postgrad Med J. 2011 Apr;87(1026):298-306. doi: 10.1136/pgmj.2008.068197. Epub 2011 Feb 4.
Hypoglycaemia is a major burden on patients and society and is often a barrier to the achievement of tight glycaemic control. Intact awareness of hypoglycaemia is crucial to recognising and treating hypoglycaemia before it becomes severe enough to impair consciousness. Repeated hypoglycaemia can lead to impaired awareness increasing the risk of severe hypoglycaemia up to sixfold. Hypoglycaemia is much less common in those with type 2 diabetes, the incidence increasing with longer duration of treatment with insulin, associated comorbidities, and in the elderly. Alcohol, advancing age and exercise may predispose to hypoglycaemia. Newer agents acting via the incretin axis are associated with low rates of hypoglycaemia. Intensification of therapy to achieve tight glucose control can increase the risk of hypoglycaemia in the outpatient as well as critical care setting. In some studies this has also been associated with increased mortality, although causality has not been proven. Insulin treated patients are currently restricted from driving heavy goods vehicles or public service vehicles, although it is unclear if those with diabetes have any higher rates of accidents than those without diabetes. Surveys show that professionals are poor at emphasising the Driver and Vehicle Licensing Agency recommendations for drivers with diabetes in the UK. At every visit, patients with diabetes on hypoglycaemic agents should be assessed for frequency, severity, and awareness of hypoglycaemia. The main therapeutic strategies for reducing hypoglycaemia are structured patient education, use of modern insulin analogues, insulin pumps, and continuous glucose monitoring. Transplantation of islets or whole pancreas is indicated in those with recurrent disabling hypoglycaemia.
低血糖是患者和社会的主要负担，通常也是实现严格血糖控制的障碍。对低血糖的完整意识对于在低血糖变得严重到足以损害意识之前识别和治疗低血糖至关重要。反复发生的低血糖会导致意识受损，使严重低血糖的风险增加至六倍。 2 型糖尿病患者发生低血糖的情况要少得多，随着胰岛素治疗时间的延长、相关合并症的增加以及老年人的增加，低血糖的发病率也会增加。酒精、年龄增长和运动可能会导致低血糖。通过肠促胰岛素途径发挥作用的新型药物与低血糖发生率低有关。为了实现严格的血糖控制而强化治疗会增加门诊和重症监护环境中发生低血糖的风险。在某些研究中，这也与死亡率增加有关，尽管尚未证明因果关系。接受胰岛素治疗的患者目前被限制驾驶重型货车或公共服务车辆，尽管尚不清楚糖尿病患者的事故发生率是否高于非糖尿病患者。调查显示，英国的专业人员在强调驾驶和车辆许可证管理局对糖尿病患者的驾驶建议方面做得很差。每次就诊时，使用低血糖药物的糖尿病患者都应评估低血糖的频率、严重程度和意识。减少低血糖的主要治疗策略是对患者进行结构化教育、使用现代胰岛素类似物、胰岛素泵和连续血糖监测。对于反复发生的致残性低血糖，应进行胰岛或整个胰腺移植。
