Hypoglycemia results from an excess of insulin action relative to blood glucose.
Increased glucose utilization during exercise can lead to hypoglycemia during, and for many hours following, a workout.
In addition, there is an attenuated sympathetic response, primarily involving epinephrine, which is largely responsible for the development or worsening of impaired hypoglycemia awareness.
0%) are appropriate include patients with a history of severe hypoglycemia, limited life expectancy, advanced micro-or macrovascular complications, extensive comorbidities, and those with long-standing DM in whom the A1C target is difficult to attain despite aggressive intervention.
Glucose-lowering agents are a common cause of hypoglycemia, with some agents more likely to produce hypoglycemia than others (TABLE 2).
The remaining classes of glucose-lowering agents--alpha-glucosidase inhibitors, ergoline derivatives (eg, bromocriptine), bile acid sequestrants (eg, colesevelam), dipeptidyl peptidase-4 (DPP-4) inhibitots, glucagon-like peptide-1 receptor (GLP-1R) agonists, biguanides (eg, metformin), amylin analog (eg, pramlintide), and thiazolidinediones (TZDs)--are considered low-risk for hypoglycemia as they lower blood glucose by 1 or more mechanisms other than increasing the blood level of insulin, or work in a glucose-dependent manner.
31) Among insulins, the slower onset, delayed peak, and longer duration of action of regular human insulin results in an increased risk of hypoglycemia compared with the rapid-acting insulin analogs aspart, glulisine, and lispro.
Concern about hypoglycemia has been a factor in the development of new glucose-lowering medications.