Prognosis

Your Organisational Guidance

ebpracticenet urges you to prioritise the following organisational guidance:

Beleid bij acute hypoglykemie met verminderd bewustzijnPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2022La prise en charge de l’hypoglycémie aiguë chez un patient présentant une diminution de la consciencePublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2022

Recurrent episodes of hypoglycaemia may lead to lowering of the blood glucose at which stress responses (i.e., glucagon secretion, stimulation of the sympathetic nervous system, and release of catecholamine, growth hormone, and cortisol) are triggered.[10][42][115]​ Alteration of these mechanisms leads to impaired awareness of hypoglycaemia (i.e., the normal warning symptoms of hypoglycaemia occur at progressively lower blood glucose levels), which increases the risk of severe hypoglycaemia.​[7][10][32]​ Avoidance of hypoglycaemia (e.g., by short-term relaxation of glycaemic targets) in these patients improves counter-regulatory hormone response and awareness of hypoglycaemia, helping to reduce the risk of recurrence.[1][3]​​

Severe and/or recurrent hypoglycaemic episodes are associated with increased mortality, both in the acute setting and long term.[116][117]​​ One retrospective study showed that self-reported episodes of severe hypoglycaemia are associated with a 3.4-fold increase in 5-year mortality.[116] However, it is unclear from the evidence whether many of the complications of hypoglycaemia that can increase mortality are a direct result of hypoglycaemia itself, or whether hypoglycaemia is a marker of patients who are more at risk of complications.​

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