CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 5, June 2012
292
AFRICA
insulin but remained less frequent than in
type 1 diabetes patients.’
This study used patients’ self-reporting
and biochemical episodes of less than 2.2
mmol/l on continuous glucose monitoring
to determine events over nine to 12
months in UK secondary care diabetes
centres. Insights from continuous glucose
monitoring has shown that the majority of
hypoglycaemic events occur at night, and
in the younger patient, do not appear to
impair cognitive function, although, the
next day, subjective well being is affected.
‘These nocturnal events may, however,
contribute to the development of impaired
awareness of hypoglycaemia’, Dr Frier
noted.
Age affects hypoglycaemic awareness,
with younger patients being able to tolerate
lower glucose levels without cognitive
dysfunction, while older patients, over
the age of 65 years have less time for
corrective action and generally experience
wider cognitive dysfunction, including
visual disturbances, inco-ordination and
impaired balance.
23
‘These symptoms
could be perceived by the attending
physician as a transient ischaemic attack
or early dementia and not correlated to
low glucose levels’, Prof Freir warned.
Hypoglycaemia provokes profound
haemodynamic
changes
through
sympatho-adrenal activation, resulting in
the profuse secretion of catecholamines.
24
This can provoke ECG-abnormalities;
prolongation of the QT interval, and
abnormalities in AV conduction (due also
to a fall in plasma potassium), which are
associated with a risk of life-threatening
cardiac arrhythmias.
Hypoglycaemic events adversely
affect quality of life and ‘having
events, increases the fear of having
further events’. Dr Frier said. The rate
of hypoglycaemic events induced by
incretin-based therapies is trivial, as these
drugs promote glucose-dependent insulin
secretion’, Prof Frier concluded.
Peter Wagenaar, Glenda Hardy, Julia Aalbers
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