Muneer Muhammad
Cardiff University, Cardiff, Heath Park, Cardiff, UK.
Adv Exp Med Biol. 2021;1307:43-69. doi: 10.1007/5584_2020_534.
In health hypoglycaemia is rare and occurs only in circumstances like extreme sports. Hypoglycaemia in type 1 Diabetes (T1D) and advanced type 2 Diabetes (T2D) are the result of interplay between absolute or relative insulin access and defective glucose counterregulation. The basic mechanism is, failure of decreasing insulin and failure of the compensatory increasing counterregulatory hormones at the background of falling blood glucose. Any person with Diabetes on anti-diabetic medication who behaves oddly in any way whatsoever is hypoglycaemic until proven otherwise. Hypoglycaemia can be a terrifying experience for a patient with Diabetes. By definition, hypoglycaemic symptoms are subjective and vary from person to person and even episode to episode in same person. Fear of iatrogenic hypoglycaemia is a major barrier in achieving optimum glycaemic control and quality of life which limits the reduction of diabetic complications. Diabetes patients with comorbidities especially with chronic renal failure, hepatic dysfunction, major limb amputation, terminal illness, cognitive dysfunction etc. are more vulnerable to hypoglycaemia. In most cases, prompt glucose intake reverts hypoglycaemia. Exogenous insulin in T1D and insulin treated advanced T2D have no control by pancreatic regulation. Moreover, failure of increase of glucagon and attenuated secretion in epinephrine causes the defective glucose counterregulation. In this comprehensive review, I will try to touch all related topics for better understanding of hypoglycaemia.
在健康状态下，低血糖很少见，仅在极端运动等情况下发生。1型糖尿病（T1D）和晚期2型糖尿病（T2D）中的低血糖是绝对或相对胰岛素供应与葡萄糖反调节缺陷之间相互作用的结果。基本机制是，在血糖下降的背景下，胰岛素分泌减少失败以及代偿性反调节激素分泌增加失败。任何正在服用抗糖尿病药物的糖尿病患者，无论以何种方式表现异常，在未被证明并非低血糖之前都应被视为低血糖。低血糖对糖尿病患者来说可能是一次可怕的经历。根据定义，低血糖症状是主观的，因人而异，甚至同一个人在不同发作时也有所不同。对医源性低血糖的恐惧是实现最佳血糖控制和生活质量的主要障碍，这限制了糖尿病并发症的减少。患有合并症的糖尿病患者，尤其是患有慢性肾衰竭、肝功能不全、大肢体截肢、晚期疾病、认知功能障碍等的患者，更容易发生低血糖。在大多数情况下，迅速摄入葡萄糖可纠正低血糖。T1D中的外源性胰岛素和胰岛素治疗的晚期T2D不受胰腺调节控制。此外，胰高血糖素分泌增加失败和肾上腺素分泌减弱导致葡萄糖反调节缺陷。在这篇综述中，我将尝试探讨所有相关主题，以便更好地理解低血糖。
