Impaired Awareness of Hypoglycemia and Nursing Approaches
Year 2026,
Volume: 5 Issue: 1
,
46
-
53
,
25.03.2026
Gamze Yeğin
,
Songül Karadağ
Abstract
Hypoglycemia is the most common metabolic side effect of diabetes treatment. Unawareness of hypoglycemia refers to a condition in which the autonomic and neuroglycopenic symptoms of hypoglycemia are diminished and, consequently, almost imperceptible. The degree to which individuals perceive hypoglycemic symptoms varies among patients. Failure to recognize hypoglycemia in a timely manner can lead to loss of consciousness, seizures, and even death. This clinical syndrome poses a significant challenge in diabetes management. Nurses have crucial roles and responsibilities in identifying individuals with impaired hypoglycemia awareness and in enhancing the knowledge and skills of diabetic individuals and their families regarding the prevention of hypoglycemia, as well as the provision of appropriate care and treatment when it occurs. During and following a hypoglycemic episode, the nurse is expected to provide close monitoring of the patient. For individuals with impaired hypoglycemia awareness, the anticipated nursing outcomes include the maintenance of blood glucose levels within the normal range and the absence of hypoglycemic signs and symptoms.
Project Number
Herhangi bir proje desteği alınmamıştır.
References
-
American Diabetes Association Professional Practice Committee. Glycemic goals and hypoglycemia: standards of care in diabetes. Diabetes Care. 2024;47(Supplement_1):111-125.
-
Amiel SA. Impaired awareness of hypoglycaemia. The British Journal of Diabetes. 2022;22(Supp1):26-31.
-
Sherr JL, Laffel LM, Liu J, Wolf W, Bispham J, Chapman KS, et al. Severe hypoglycemia and impaired awareness of hypoglycemia persist in people with type 1 diabetes despite use of diabetes technology: Results from a cross-sectional survey. Diabetes Care. 2024;47(6):941-947.
-
Hölzen L, Schultes B, Meyhöfer SM, Meyhöfer S. Hypoglycemia unawareness—a review on pathophysiology and clinical implications. Biomedicines. 2024;12(2):391.
-
Mathew P, Thoppil D. Hypoglycemia. StatPearls. 2022. Erişim adresi: https://www.ncbi.nlm.nih.gov/books/NBK534841/ Erişim tarihi: 29.12.2024.
-
Türkiye Endokrinoloji ve Metabolizma Derneği. Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu. Ankara; 2024.
-
McNeilly AD, McCrimmon RJ. Impaired hypoglycaemia awareness in type 1 diabetes: lessons from the lab. Diabetologia. 2018;61(4):743-750.
-
Sharifi Y, Ebrahimpur M, Tamehrizadeh SS. Hypoglycemic unawareness: challenges, triggers, and recommendations in patients with hypoglycemic unawareness: a case report. J Med Case Reports. 2022;16:283.
-
Thieu VT, Mitchell BD, Varnado OJ, Frier BM. Treatment and prevention of severe hypoglycaemia in people with diabetes: Current and new formulations of glucagon. Diabetes Obes Metab. 2020;22(4):469-479.
-
Hussein Z, Kamaruddin NA, Chan SP, Jain A, Uppal S, Bebakar W. Hypoglycemia awareness among insulin-treated patients with diabetes in Malaysia: A cohort subanalysis of the HAT study. Diabetes Research and Clinical Practice. 2017;133:40-49.
-
Erol Ö. Hipoglisemi korkusu ve yönetiminde hemşirenin rolü. Turkiye Klinikleri J Nurs Sci. 2012;4(1):37-44.
-
Meijel LA, Vegt F, Abbink EJ, Rutters F, Schram MT, Klauw MM, et al. High prevalence of impaired awareness of hypoglycemia and severe hypoglycemia among people with insulin-treated type 2 diabetes: The Dutch Diabetes Pearl Cohort. BMJ Open Diabetes Research & Care. 2020;8:e000935.
-
Surrati AMQ, Alanazi AA, Bukhari SS, Alfadhli EM. Hypoglycemia unawareness among insulin-treated diabetic patients in Madinah, Saudi Arabia: prevalence and risk factors. Front. Endocrinol. 2023;14:1239524.
-
Clarke WL, Cox DJ, Gonder-Frederick LA, Julian D, Schlundt D, Polonsky W. Reduced awareness of hypoglycemia in adults with IDDM. A prospective study of hypoglycemic frequency and associated symptoms. Diabetes Care. 1995;18(4):517-522.
-
Thompson RF, Spencer WA. Habituation: a model phenomenon for the study of neuronal substrates of behavior. Psychol Rev. 1966;73:16-43.
-
Macon EL, Devore MH, Lin YK, Music MB, Wooten M, McMullen CA, et al. Current and future therapies to treat impaired awareness of hypoglycemia. Front. Pharmacol. 2023;14:1271814.
-
Cryer PE. Hypoglycemia-associated autonomic failure in diabetes. Am J Physiol Endocrinol Metab. 2001;281:E1115-E1121.
-
Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care. 2003;26:1902-1912.
-
Magistretti PJ, Allaman I. Lactate in the brain: From metabolic end-product to signalling molecule. Nat Rev Neurosci. 2018;19:235-249.
-
Gerich JE, Langlois M, Noacco C, Karam JH, Forsham PH. Lack of glucagon response to hypoglycemia in diabetes: Evidence for an intrinsic pancreatic alpha cell defect. Science. 1973;182:171-173.
-
Cryer PE. Minireview: Glucagon in the pathogenesis of hypoglycemia and hyperglycemia in diabetes. Endocrinology. 2012;153:1039-1048.
-
Zhou H, Zhang T, Harmon JS, Bryan J, Robertson RP. Zinc, not insulin, regulates the rat α-cell response to hypoglycemia in vivo. Diabetes. 2007;56:1107-1112.
-
De Feo P, Perriello G, Torlone E, Ventura MM, Santeusanio F, Brunetti P, et al. Demonstration of a role for growth hormone in glucose counterregulation. Am J Physiol. 1989;256:E835-E843.
-
Rizza RA, Cryer PE, Gerich JE. Role of glucagon, catecholamines, and growth hormone in human glucose counterregulation. Effects of somatostatin and combined alpha- and beta-adrenergic blockade on plasma glucose recovery and glucose flux rates after insulin-induced hypoglycemia. J Clin Invest. 1979;64:62-71.
-
Davis SN, Shavers C, Costa F, Mosqueda-Garcia R. Role of cortisol in the pathogenesis of deficient counterregulation after antecedent hypoglycemia in normal humans. J Clin Invest. 1996;98:680-691.
-
Schmid SM, Hallschmid M, Schultes B. The metabolic burden of sleep loss. Lancet Diabetes Endocrinol. 2015;3:52-62.
-
Mathew P, Thoppil D, McClinton T. Hypoglycemia (Nursing). StatPearls. 2022. Erişim adresi: https://www.ncbi.nlm.nih.gov/books/NBK568695/ Erişim tarihi: 29.12.2024.
-
Akdemir N. İç Hastalıkları ve Hemşirelik Bakımı. 7. Baskı, Ankara: Akademisyen Kitapevi A.Ş.; 2021:951-952.
-
Lipska KJ. Patient education: Hypoglycemia (low blood glucose) in people with diabetes (Beyond the Basics). Up To Date. 2024;1-9.
-
Lowe RN, Williams B, Claus LW. Diabetes: how to manage patients experiencing hypoglycaemia. Drugs Context. 2022;14(11):9-11.
Hipoglisemi Farkındalığında Bozulma ve Hemşirelik Yaklaşımları
Year 2026,
Volume: 5 Issue: 1
,
46
-
53
,
25.03.2026
Gamze Yeğin
,
Songül Karadağ
Abstract
Hipoglisemi, diyabet tedavisinin en yaygın metabolik yan etkisidir. Hipogliseminin farkında olmama, hipogliseminin otonomik ve nöroglikopenik semptomlarının azaldığı ve neredeyse algılanamadığı bir durumu tanımlamaktadır. Hipoglisemi semptomlarını hissetme derecesi bireyler arasında farklılık göstermektedir. Hipoglisemiyi zamanında fark edememek, bilinç kaybına, nöbete hatta ölüme yol açabilir. Bu klinik sendrom diyabet tedavisinde özellikle büyük bir zorluk teşkil etmektedir. Hemşirelerin, hipoglisemi farkındalığı bozulmuş olan diyabetlilerin tanılanması, diyabetli birey ve ailelerinin hipogliseminin önlenmesi, gelişmesi durumunda da uygun bakım ve tedavinin sağlanmasına ilişkin bilgi ve becerilerinin geliştirilmesi yönünde önemli görev ve sorumlulukları bulunmaktadır.
Supporting Institution
Herhangi bir proje desteği alınmamıştır.
Project Number
Herhangi bir proje desteği alınmamıştır.
References
-
American Diabetes Association Professional Practice Committee. Glycemic goals and hypoglycemia: standards of care in diabetes. Diabetes Care. 2024;47(Supplement_1):111-125.
-
Amiel SA. Impaired awareness of hypoglycaemia. The British Journal of Diabetes. 2022;22(Supp1):26-31.
-
Sherr JL, Laffel LM, Liu J, Wolf W, Bispham J, Chapman KS, et al. Severe hypoglycemia and impaired awareness of hypoglycemia persist in people with type 1 diabetes despite use of diabetes technology: Results from a cross-sectional survey. Diabetes Care. 2024;47(6):941-947.
-
Hölzen L, Schultes B, Meyhöfer SM, Meyhöfer S. Hypoglycemia unawareness—a review on pathophysiology and clinical implications. Biomedicines. 2024;12(2):391.
-
Mathew P, Thoppil D. Hypoglycemia. StatPearls. 2022. Erişim adresi: https://www.ncbi.nlm.nih.gov/books/NBK534841/ Erişim tarihi: 29.12.2024.
-
Türkiye Endokrinoloji ve Metabolizma Derneği. Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu. Ankara; 2024.
-
McNeilly AD, McCrimmon RJ. Impaired hypoglycaemia awareness in type 1 diabetes: lessons from the lab. Diabetologia. 2018;61(4):743-750.
-
Sharifi Y, Ebrahimpur M, Tamehrizadeh SS. Hypoglycemic unawareness: challenges, triggers, and recommendations in patients with hypoglycemic unawareness: a case report. J Med Case Reports. 2022;16:283.
-
Thieu VT, Mitchell BD, Varnado OJ, Frier BM. Treatment and prevention of severe hypoglycaemia in people with diabetes: Current and new formulations of glucagon. Diabetes Obes Metab. 2020;22(4):469-479.
-
Hussein Z, Kamaruddin NA, Chan SP, Jain A, Uppal S, Bebakar W. Hypoglycemia awareness among insulin-treated patients with diabetes in Malaysia: A cohort subanalysis of the HAT study. Diabetes Research and Clinical Practice. 2017;133:40-49.
-
Erol Ö. Hipoglisemi korkusu ve yönetiminde hemşirenin rolü. Turkiye Klinikleri J Nurs Sci. 2012;4(1):37-44.
-
Meijel LA, Vegt F, Abbink EJ, Rutters F, Schram MT, Klauw MM, et al. High prevalence of impaired awareness of hypoglycemia and severe hypoglycemia among people with insulin-treated type 2 diabetes: The Dutch Diabetes Pearl Cohort. BMJ Open Diabetes Research & Care. 2020;8:e000935.
-
Surrati AMQ, Alanazi AA, Bukhari SS, Alfadhli EM. Hypoglycemia unawareness among insulin-treated diabetic patients in Madinah, Saudi Arabia: prevalence and risk factors. Front. Endocrinol. 2023;14:1239524.
-
Clarke WL, Cox DJ, Gonder-Frederick LA, Julian D, Schlundt D, Polonsky W. Reduced awareness of hypoglycemia in adults with IDDM. A prospective study of hypoglycemic frequency and associated symptoms. Diabetes Care. 1995;18(4):517-522.
-
Thompson RF, Spencer WA. Habituation: a model phenomenon for the study of neuronal substrates of behavior. Psychol Rev. 1966;73:16-43.
-
Macon EL, Devore MH, Lin YK, Music MB, Wooten M, McMullen CA, et al. Current and future therapies to treat impaired awareness of hypoglycemia. Front. Pharmacol. 2023;14:1271814.
-
Cryer PE. Hypoglycemia-associated autonomic failure in diabetes. Am J Physiol Endocrinol Metab. 2001;281:E1115-E1121.
-
Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care. 2003;26:1902-1912.
-
Magistretti PJ, Allaman I. Lactate in the brain: From metabolic end-product to signalling molecule. Nat Rev Neurosci. 2018;19:235-249.
-
Gerich JE, Langlois M, Noacco C, Karam JH, Forsham PH. Lack of glucagon response to hypoglycemia in diabetes: Evidence for an intrinsic pancreatic alpha cell defect. Science. 1973;182:171-173.
-
Cryer PE. Minireview: Glucagon in the pathogenesis of hypoglycemia and hyperglycemia in diabetes. Endocrinology. 2012;153:1039-1048.
-
Zhou H, Zhang T, Harmon JS, Bryan J, Robertson RP. Zinc, not insulin, regulates the rat α-cell response to hypoglycemia in vivo. Diabetes. 2007;56:1107-1112.
-
De Feo P, Perriello G, Torlone E, Ventura MM, Santeusanio F, Brunetti P, et al. Demonstration of a role for growth hormone in glucose counterregulation. Am J Physiol. 1989;256:E835-E843.
-
Rizza RA, Cryer PE, Gerich JE. Role of glucagon, catecholamines, and growth hormone in human glucose counterregulation. Effects of somatostatin and combined alpha- and beta-adrenergic blockade on plasma glucose recovery and glucose flux rates after insulin-induced hypoglycemia. J Clin Invest. 1979;64:62-71.
-
Davis SN, Shavers C, Costa F, Mosqueda-Garcia R. Role of cortisol in the pathogenesis of deficient counterregulation after antecedent hypoglycemia in normal humans. J Clin Invest. 1996;98:680-691.
-
Schmid SM, Hallschmid M, Schultes B. The metabolic burden of sleep loss. Lancet Diabetes Endocrinol. 2015;3:52-62.
-
Mathew P, Thoppil D, McClinton T. Hypoglycemia (Nursing). StatPearls. 2022. Erişim adresi: https://www.ncbi.nlm.nih.gov/books/NBK568695/ Erişim tarihi: 29.12.2024.
-
Akdemir N. İç Hastalıkları ve Hemşirelik Bakımı. 7. Baskı, Ankara: Akademisyen Kitapevi A.Ş.; 2021:951-952.
-
Lipska KJ. Patient education: Hypoglycemia (low blood glucose) in people with diabetes (Beyond the Basics). Up To Date. 2024;1-9.
-
Lowe RN, Williams B, Claus LW. Diabetes: how to manage patients experiencing hypoglycaemia. Drugs Context. 2022;14(11):9-11.