PDF(Pubmed)
Abstract：
Hypoglycemia is a particular problem in people with diabetes while it can also occur in other clinical circumstances. Hypoglycemia unawareness describes a condition in which autonomic and neuroglycopenic symptoms of hypoglycemia decrease and hence are hardly perceivable. A failure to recognize hypoglycemia in time can lead to unconsciousness, seizure, and even death. The risk factors include intensive glycemic control, prior episodes of severe hypoglycemia, long duration of diabetes, alcohol consumption, exercise, renal failure, and sepsis. The pathophysiological mechanisms are manifold, but mainly concern altered brain glucose sensing, cerebral adaptations, and an impaired hormonal counterregulation with an attenuated release of glucagon, epinephrine, growth hormone, and other hormones, as well as impaired autonomous and neuroglycopenic symptoms. Physiologically, this counterregulatory response causes blood glucose levels to rise. The impaired hormonal counterregulatory response to recurrent hypoglycemia can lead to a vicious cycle of frequent and poorly recognized hypoglycemic episodes. There is a shift in glycemic threshold to trigger hormonal counterregulation, resulting in hypoglycemia-associated autonomic failure and leading to the clinical syndrome of hypoglycemia unawareness. This clinical syndrome represents a particularly great challenge in diabetes treatment and, thus, prevention of hypoglycemia is crucial in diabetes management. This mini-review provides an overview of hypoglycemia and the associated severe complication of impaired hypoglycemia awareness and its symptoms, pathophysiology, risk factors, consequences, as well as therapeutic strategies.
摘要：
低血糖症是糖尿病患者的特殊问题，而在其他临床情况下也可能发生。低血糖症的无意识描述了低血糖症的自主神经和神经性症状减少的情况，因此很难感知。未能及时识别低血糖会导致意识不清，癫痫发作,甚至死亡。危险因素包括强化血糖控制，之前的严重低血糖发作，糖尿病持续时间长，酒精消费,锻炼,肾功能衰竭,还有败血症.病理生理机制是多方面的，但主要关注大脑葡萄糖感应的改变，大脑适应,以及由于胰高血糖素释放减弱而导致的激素反调节受损，肾上腺素,生长激素,和其他荷尔蒙，以及受损的自主和神经血糖减少症状。生理学上,这种反调节反应导致血糖水平上升.对复发性低血糖的受损的激素反调节反应可导致频繁且难以识别的低血糖发作的恶性循环。血糖阈值发生了变化，触发了荷尔蒙的反调节，导致低血糖相关的自主神经功能衰竭，并导致低血糖的临床综合征。这种临床综合征代表了糖尿病治疗的一个特别巨大的挑战，因此，预防低血糖在糖尿病管理中至关重要.这篇小型综述概述了低血糖和低血糖意识受损的相关严重并发症及其症状。病理生理学,危险因素，后果,以及治疗策略。
