Drug-induced hypoglycemia in type 2 diabetic patients

Abstract

Drug-induced hypoglycemia is one of the most relevant limiting factors in obtaining good metabolic control necessary to prevent angiopathy in diabetic patients. Mortality associated with insulin therapy is estimated as 2-4%. Hypoglycemic coma is a life-threatening state. Prolonged hypoglycemia may cause irreversible neurological deficiencies. Hypoglycemia may induce cardiac ischemia and arrhythmias. The risk factors of severe hypoglycemia include intensive insulin therapy, old age, autonomic neuropathy, impair secretion of counterregulatory hormones, renal failure, liver injury and previous episode of severe hypoglycemia. Hypoglycemia may be side effect of treatment with insulin, sulfonylureas, glinides, DPP-4 inhibitors. Metformin in monotherapy does not cause hypoglycemia. Combined therapy (insulin and metformin) may reduce the risk of hypoglycemia. Education of patients and their families, availability of self-control, appropriate management of type 2 diabetes makes possible to obtain good metabolic control without severe hypoglycemia.