Causes and Risk Factors
Hypoglycaemia in diabetes typically occurs as a result of medical treatment, particularly with insulin, sulfonylureas (SUs) or glinides. Certain patient characteristics and disease factors put people at higher risk:
Risk factors for hypoglycaemia1-4
| Type 1 diabetes | Type 2 diabetes (on insulin or SUs) |
|---|---|
|
|
In addition, specific behaviours and insulin-related factors may increase the risk of nocturnal hypoglycaemia:5,6
- Missed meal, alcohol consumption
- Unplanned physical activity, especially strenuous
- Failure to check blood glucose at bedtime
- Dose of basal insulin too high
- Too much rapid-acting insulin to correct high glucose, particularly at bedtime, or to cover bedtime snacks
- Premix or short-acting insulin before dinner
- NPH insulin (isophane) in the evening
References
- UK Hypoglycaemia Study Group. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia 2007;50:1140.
- International Hypoglycaemia Study Group. Minimizing hypoglycemia in diabetes. Diabetes Care 2015;38:1583.
- Inzucchi SE et al. Management of hyperglycemia in Type 2 diabetes, 2015: A patient-centered approach. Diabetes Care 2015;38:
- Weinstock RS et al. Risk factors associated with severe hypoglycemia in older adults ith Type 1 diabetes. Diabetes Care 2016 Apr;39:603.
- Lipska KJ et al. HbA1c and risk of severe hypoglycemia in Type 2 diabetes. Diabetes Care 2013;36:3535.
- Brunton SA. Nocturnal hypoglycemia: Answering the challenge with long-acting insulin analogs. MedGenMed 2007;9:38.