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In diabetes, hypoglycaemia generally arises as a consequence of pharmacologic treatment that causes blood glucose levels to drop below the normal range. While mild hypoglycaemia usually resolves with prompt ingestion of carbohydrates, more significantly reduced glucose levels can impair cognitive function, lead to loss of consciousness, and even threaten life. The link between hypoglycaemia and increased mortality has been documented in several studies.1
Nocturnal hypoglycaemia poses a particular challenge because the sleeping patient is not in a position to intervene and many episodes are asymptomatic. Repeated exposure to nocturnal hypoglycaemia can blunt counterregulatory mechanisms, with potentially serious clinical consequences.2
Intensive glucose-lowering therapy may not achieve its purpose – avoidance of mortality and morbidity from diabetes complications – unless hypoglycaemia risk can be managed. Strategies to minimize hypoglycaemia can help patients safely achieve glycaemic control and thus prevent or delay complications.
- 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. Published in both Diabetes Care 2017 Jan; 40(1): 155-157 and Diabetologia 2017;6-:3-6.
- Cryer PE. Glycemic goals in diabetes: trade-off between glycemic control and iatrogenic hypoglycemia. Diabetes 2014;63:2188.