Some points to remember
This is a very systematic and informative article.
It is a known fact that a diabetic patient is under constant threat of
hypoglycaemia. With insulin it is the most frequent adverse effect. A
patient on insulin needs proper titration of the suitable insulin form and
placing of doses to prevent drastic fluctuations in either direction.
Another way of blood glucose control is using the continuous subcutaneous
insulin infusion (CSII). Though it has its share of complexities, it can
provide better control and more flexibility in life.
Sulfonylureas, being insulin secretagogues, share hypoglycaemia too. It is
essential to prescribe a sulfonylurea that can preserve glucose dependent
insulin inhibition and reflex glucagon release eg. Glimepiride.. This
itself can bring down the frequency of hypoglycaemic episodes.
Insulin sensitizers like metformin are relatively free from this problem.
While dealing with a hypoglycaemic patient, it is important to remember
that long standing diabetes can lead to loss of adrenergic symptoms and
the patient may directly present with neuroglycopenic complaints. Also,
glucagon is more of an adjunct and needs glucose supplementation anyway.
Competing interests: No competing interests