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World J Diabetes. Dec 15, 2021; 12(12): 2036-2049
Published online Dec 15, 2021. doi: 10.4239/wjd.v12.i12.2036
Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention
Afif Nakhleh, Naim Shehadeh
Afif Nakhleh, Naim Shehadeh, Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa 3109601, Israel
Author contributions: Nakhleh A drafted the manuscript; Both authors edited and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Afif Nakhleh, MD, Doctor, Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, HaAliya HaShniya Street 8, Haifa 3109601, Israel. anakhleh@gmail.com
Received: September 3, 2021
Peer-review started: September 3, 2021
First decision: October 3, 2021
Revised: October 16, 2021
Accepted: December 7, 2021
Article in press: December 7, 2021
Published online: December 15, 2021
Processing time: 104 Days and 3.6 Hours
Abstract

Hypoglycemia is a common complication in patients with diabetes, mainly in those treated with insulin, sulfonylurea, or glinide. Impairments in counterregulatory responses and hypoglycemia unawareness constitute the main risk factors for severe hypoglycemia. Episodes of hypoglycemia are associated with physical and psychological morbidity. The fear of hypoglycemia constitutes a barrier that impairs the patient’s ability to reach good glycemic control. To prevent hypoglycemia, much effort must be invested in patient education regarding risk factors, warning signs, and treatment of hypoglycemia at an early stage, together with setting personalized goals for glycemic control. In this review, we present a comprehensive update on the treatment and prevention of hypoglycemia in type 1 and type 2 diabetic patients.

Keywords: Hypoglycemia; Diabetes mellitus; Insulin; Glucagon; Glucose; Continuous glucose monitoring

Core Tip: Hypoglycemia in diabetes is associated with increased morbidity and constitutes a barrier to glycemic control. Great effort must be invested in patient education on hypoglycemia prevention and management. Herein we present the recent data on the treatment and prevention of hypoglycemia in diabetes, with a focus on the benefits of treatment adjustment and the role of continuous glucose monitoring.