Prognosis

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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 hypoglycemia 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]​[41]​[114]​ Alteration of these mechanisms leads to impaired awareness of hypoglycemia (i.e., the normal warning symptoms of hypoglycemia occur at progressively lower blood glucose levels), which increases the risk of severe hypoglycemia.​[7]​[10]​[32]​ Avoidance of hypoglycemia (e.g., by short-term relaxation of glycemic targets) in these patients improves counterregulatory hormone response and awareness of hypoglycemia, helping to reduce the risk of recurrence.[1]​[3]​

Severe and/or recurrent hypoglycemic episodes are associated with increased mortality, both in the acute setting and long term.[115][116]​ One retrospective study showed that self-reported episodes of severe hypoglycemia are associated with a 3.4-fold increase in 5-year mortality.[115] However, it is unclear from the evidence whether many of the complications of hypoglycemia that can increase mortality are a direct result of hypoglycemia itself, or whether hypoglycemia is a marker of patients who are more at risk of complications.​

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