Hypoglycemia

Consequences

Brain dysfunction

• Severe prolonged episodes with convulsions in younger children have the potential to harm the developing brain including the occurrence of secondary epilepsy
• Transient episodes have important implications for school and social wellbeing including
  • decreased awareness and cognitive deficits
  • injury or accident during an episode
  • fear of hypoglycemia with consequent deterioration of glycemic control
• The development of hypoglycemic unawareness should raise the possibility of antecedent unrecognized hypoglycemia, particularly during the night

Nocturnal hypoglycemia

• Is frequent, often prolonged, usually asymptomatic and does not necessarily disturb sleep patterns
• Counter-regulatory responses may be impaired during sleep
• Should be suspected if
  • pre-breakfast BG is low
  • confusional states, nightmares or seizures occur during the night, or impaired thinking, lethargy, altered mood or headaches are experienced on waking
• Can only be confirmed by BG tests at regular intervals during the night
• The association with subsequent hypoglycemic unawareness may be reversed by maintaining BG above 3 mmol/l during the night
• Is not regularly predictable on the basis of a bedtime BG level (predictability is improved by BG measurement towards midnight)