The most frequent complication is iatrogenic hypoglycemia that is often associated with autonomic and neuroglycopenic symptoms. Furthermore, hypoglycemia causes acute cardiovascular effects, which may explain some of the typical symptoms: ischemia, QT prolongation, and arrhythmia.
Studies have identified advanced age, malnutrition, active cancer, end-stage renal disease, liver disease, congestive heart failure, and other patient factors as contributors to hypoglycemia risk.
The use of oral agents, failure to adjust diabetes regimens in response to decreases in oral intake, and unexpected deviation from normal hospital routines have been some of the most common iatrogenic factors contributing to hypoglycemia.
Iatrogenic hypoglycemia (IH) involves reduced motivation and compliance with achieving good glycemic control that minimizes the risk of diabetic complications, with a consequent increase in cardiovascular (CV) and neurological morbidities.
Clinicians have recognized the problem of iatrogenic hypoglycemia since the first use of insulin in 1922.
Classically, hypoglycemia is defined by the Whipple triad: the presence of low blood sugar; autonomic and neuroglycopenic symptoms; and reversal of the symptoms after restoration of the blood glucose level to normal.
Iatrogenic hypoglycemia
*Causes recurrent morbidity in most people with type 1 diabetes and many with advanced type 2 diabetes and is sometimes fatal,
*Compromises physiological and behavioral defenses against subsequent falling plasma glucose concentrations and thus causes a vicious cycle of recurrent hypoglycemia, and
*Precludes maintenance of euglycemia over a lifetime of diabetes and therefore full realization of the vascular benefits of glycemic control.
Iatrogenic hypoglycemia often has a profound impact on the lives of people with diabetes (as well as on their physiological defenses against subsequent hypoglycemia).
The experience of an episode can range from unrecognized to extremely uncomfortable and disrupting. As a group, people with diabetes fear hypoglycemia more than they fear the long-term complications of diabetes.
Iatrogenic hypoglycemia
