Hypoglycemia primary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

The main stay in primary prevention is patient education about symptoms, blood glucose level control, and hypoglycemia treatment. Reactive hypoglycemia prevention depends on changing eating habits to smaller meals and avoiding excessive sugar intake.

The main pillar in primary prevention is to educate the patient about symptoms and treatment.

• Patient should be able to recognize early symptoms.
• Frequent self-monitoring of blood glucose:^[2]
  • Continuous glucose monitoring may facilitate glycemic control avoiding frequent punctures and providing the records over days or weeks depending upon the device used.
  • It should be more restricted for patients using alcohol and B-blockers as B-blockers mask symptoms of hypoglycemia.
  • Glycemic control can minimize complications and prevent cardiovascular events.^[3]

• Long-acting insulin, mixed with short-acting ones as the pre-meal bolus insulin, reduce the risk of hypoglycemia especially before meals and sleep.

• Bedtime snacks are the best way to prevent nocturnal hypoglycemia.^[4]

• Sensor-augmented insulin pump is a method to measure blood glucose level during sleeping frequently and stop insulin injection in response to hypoglycemia.^[5]

• Frequent self-monitoring of blood glucose
• Reduce insulin doses before exercise
• Carbohydrate ingestion before exercise

• The risk of further episodes of diabetic hypoglycemia can often be reduced by decreasing the insulin dose or other medications. Meticulous attention to blood sugar balance during unusual hours, higher levels of exercise, or alcohol intake are other important measures.
• Monitor for inappropriate prescribing.
• Many of inborn errors of metabolism require avoiding or shortening of fasting intervals or taking extra carbohydrates.
• For the more severe disorders, such as type 1 glycogen storage disease, this may be supplied in the form of cornstarch every few hours or by continuous gastric infusion.
• Hypoglycemia due to dumping syndrome: Mixed diets including fat and protein with carbohydrates may slow digestion and reduce early insulin secretion. Glucosidase inhibitor which slows starch digestion are helpful in this conditions.

• Reactive hypoglycemia: Change eating patterns by taking smaller meals, avoiding excessive sugar intake and mixed meals.