Test Your Knowledge Answer #443

Intensive control of diabetes is associated with an increased risk of hypoglycemia. This association was demonstrated in the Diabetes Control and Complications Trial (DCCT), which showed that persons with intensively managed type 1 diabetes had a 3-fold greater risk for severe hypoglycemia compared with those treated less intensively. This risk may be reduced by using a more physiologic insulin; by using more physiologic insulin regimens; by paying more attention to meal planning; by recognizing the effects of exercise on glucose levels; and by learning to adjust insulin dosage and caloric intake based on exercise.

 

More frequent episodes of hypoglycemia are associated with a greater chance that the classic warning symptoms of hypoglycemia (the so-called adrenergic symptoms, which include diaphoresis, palpitations, and anxiety) will not be appreciated by patients and that a higher prevalence of hypoglycemia unawareness will occur; this is characterized by less frequent adrenergic symptoms and more frequent neurogenic symptoms (e.g., altered cognitive function and confusion), which are the major clinical manifestations of hypoglycemia.

 

Intensification of treatment and improved glycemic control do not increase the risk of developing coronary artery disease and have been shown to reduce albumin excretion rates in patients who have microalbuminuria (the early renal damage from diabetes). Although the use of insulin pumps has been shown to reduce the incidence of hypoglycemia, this is not the only form of therapy used to intensify treatment.