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Unsuspected hypoglycaemia, haemoglobin A1 and diabetic control
The Quarterly Journal of Medicine
|January 1, 1981
Summary
Hypoglycaemia, or low blood sugar, is common in insulin-treated diabetes and often asymptomatic. Near-normal HbA1 levels may mask recurrent low blood glucose events, requiring careful interpretation for optimal diabetes management.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Diabetes Mellitus Research
Background:
- Effective diabetes management aims to maintain optimal blood glucose levels.
- Hypoglycaemia is a significant complication of insulin therapy.
- Assessing true glycaemic control requires evaluating both high and low blood glucose events.
Purpose of the Study:
- To assess the prevalence and characteristics of hypoglycaemia in insulin-treated diabetic patients.
- To evaluate the relationship between hypoglycaemia and conventional diabetes control markers.
- To investigate potential mechanisms for the absence of rebound hyperglycaemia after hypoglycaemic episodes.
Main Methods:
- In-patient 24-hour plasma glucose profiles and haemoglobin A1 (HbA1) estimation were performed.
- Out-patient pre-prandial capillary blood glucose monitoring was conducted over three days.
- Urinary cortisol/creatinine ratios were analyzed to assess nocturnal hypoglycaemia and rebound effects.
Main Results:
- 39% of patients experienced hypoglycaemia (plasma glucose ≤ 2 mmol/l), often without symptoms.
- 61% of patients on out-patient monitoring had hypoglycaemia.
- Conventional control measures (fasting glucose, HbA1) were lower in patients with hypoglycaemia; diabetic retinopathy was less prevalent.
Conclusions:
- Recurrent hypoglycaemia is common in insulin-treated diabetics and may not be detected by standard tests.
- Near-normal HbA1 levels can mask underlying hypoglycaemia, necessitating cautious interpretation.
- The absence of rebound hyperglycaemia was not linked to autonomic neuropathy or nocturnal hormonal responses.
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