Prolonged hypoglycemia due to sulfonylurea in an elderly woman

Overuse of antidiabetic medications is the most common cause of hypoglycemia in diabetic subjects. Here, we report a case of hypoglycemia associated with sulfonylurea administration. An 83-year-old female patient was admitted to the emergency department with complaints of loss of consciousness and fainting. The patient's blood glucose level was of 33 mg/dL, and she received emergency treatment with an intravenous 10% dextrose solution. In conclusion, sulfonylureas in combination with antidiabetic therapy increase the risk of hypoglycemic events in elderly patients with renal failure. Therefore, we suggest that physicians should closely monitor these patients for hypoglycemia and, preferably, use drugs that have less hypoglycemia side effects

Hipoglicemia induzida por insulina como fator desencadeador de déficit cognitivo em crianças portadoras de diabetes mellitus tipo 1 / Insulin-induced hypoglycemia as a triggering factor of cognitive impairment in children with type 1 diabetes mellitus

O Diabetes mellitus tipo 1 (DM1) surge mais frequentemente em crianças e caracteriza-se pela deficiência total de insulina, o que torna a insulinoterapia necessária. Durante a insulinoterapia a hipoglicemia é uma reação adversa comum e poderia acarretar dano cerebral associado ao déficit cognitivo (DC). Porém, o assunto é controverso, já que existem estudos nos quais a associação DC e hipoglicemia induzida por insulina (HII) não foi comprovada. Desse modo, com o objetivo de esclarecer esta questão utilizou-se o PubMed (www.ncbi.nlm.nih.gov/pubmed), um banco de dados que possui mais de 20 milhões de trabalhos científicos disponíveis on line. Utilizou-se as palavras-chave: ?hypoglycemia and cognitive function and children? ou ?diabetes and cognitive deficit and children?. Selecionou-se publicações do período entre 1960 e 2010. Excluiu-se estudos em animais experimentais, investigações restrita a adultos e estudos nos quais a avaliação do DC ocorreu durante o episódio de HII. Assim, investigações que associaram DC com HII e dano cerebral (estrutural e funcional) foram analisados. Desta maneira, após uma cuidadosa avaliação dos estudos selecionados concluiu-se que existe uma forte correlação entre dano cerebral causado pela hipoglicemia e DC envolvendo múltiplos fatores: duração, intensidade e frequência dos episódios de HII, precocidade no surgimento do DM e duração da doença. Conclui-se que é relevante o contínuo e intensivo cuidado e educação da criança portadora de DM1 submetida à insulinoterapia, com vistas a reduzir a possibilidade do dano cerebral e DC.

Type 1 diabetes (T1D) starts frequently in children and and it is characterized by total insulin deficiency and for this reason insulin therapy is necessary. During insulin therapy, hypoglycemia is a very common side effect and could bring brain damage associated with cognitive deficit (CD). However, there are controversies considering that there are studies in which the association of insulin induced hypoglycemia (IIH) and CD were not comproved. Therefore, to clarify this question it was used PubMed (www.ncbi.nlm.nih.gov/pubmed), with more than 20 millions of on line available publications. The key words ?hypoglycemia and cognitive function and children? or ?diabetes and cognitive deficit and children? were employed. The publications between 1960 and 2010 were selected. Studies from experimental animals, investigations restrict to adult people and studies in which the evaluation of CD occurred during the episode of IIH were excluded. Therefore, investigations that associated CD with IIH and brain damage (structural and functional) were analyzed. Consequently, after a care full evaluation from selected studies it was concluded that there is a strong relationship between brain damage caused by hypoglycemia and CD involving several factors: duration, intensity and frequency of IIH episodes, precocity of T1D and duration of the disease. It was concluded that the intensive care and education of children with T1D submitted to insulinoterapy is very important to reduce the possibility of brain damage and CD.