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What Is Relative Hypoglycemia

Relative hypoglycemia refers to a drop in blood glucose levels from an individual's normal baseline, even if the absolute number remains in a conventionally normal range. The document discusses evidence that relative hypoglycemia can trigger hormonal and neurological responses similar to true hypoglycemia. It may occur more frequently and have adverse effects in diabetic patients with poor chronic glycemic control or ICU patients with distributive shock. Studies show an association between more frequent relative hypoglycemia and increased mortality risk in ICU patients. Further research is still needed but relative hypoglycemia appears to be a meaningful clinical concept with potentially harmful consequences.

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Boris Boskholov
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174 views30 pages

What Is Relative Hypoglycemia

Relative hypoglycemia refers to a drop in blood glucose levels from an individual's normal baseline, even if the absolute number remains in a conventionally normal range. The document discusses evidence that relative hypoglycemia can trigger hormonal and neurological responses similar to true hypoglycemia. It may occur more frequently and have adverse effects in diabetic patients with poor chronic glycemic control or ICU patients with distributive shock. Studies show an association between more frequent relative hypoglycemia and increased mortality risk in ICU patients. Further research is still needed but relative hypoglycemia appears to be a meaningful clinical concept with potentially harmful consequences.

Uploaded by

Boris Boskholov
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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What is relative hypoglycemia?

Rinaldo Bellomo
Melbourne
Australia
• High rate of hypoglycemia and 3% excess
mortality in intensive control group

• Cardiovascular cause of death more


common in the intensive control group

• Hypo independently associated with


increased mortality

• Association strongest among patients with


distributive shock
hypoglycemia per se may be harmful
Hypoglycemia

Chemoreceptors in
carotid glomus

Cardiac baroreceptor sensitivity


Heart rate variability
Sympathetic outflow

Cardiovascular instability
Previous hypoglycaemia increases hypothalamic activation
during subsequent hypoglycaemia
The back-to-front glucagon response in diabetes
Hypoglycemia is ”silent” in ICU
Which makes it particularly bad

10 • Activation of hormonal counterregulation


Blood Glucose Level (mmol/L)

9 – Adrenaline
– Noradrenaline
8
– Cortisol
7 – Growth hormone
6 – Glucagon invisible
• Neuroglycopenic symptoms
5
– Confusion
4 3.9 – Weakness
No – Drowsiness
3 Diabetes
– etc…
Diabetic patients may be different
The concept of relative hypoglycemia

10 • Evidence from ’clamp studies’


Blood Glucose Level (mmol/L)

9
• 30% drop from baseline triggers
8 hormonal/neuroglucopenic
7 30% responses (relative hypoglycemia)
6 • Hypoglycemia counter-regulation
5 30% Diabetes can occur within a normal blood
4 glucose range in patients with
No chronic poor glucose control
3 Diabetes

The adverse effects of hypoglycemia may happen


at a normal glucose level in diabetics
Do we have reasons to believe this is true?
10-14 mmol/l

Conventional
range
Chronic glycemia and relative hypoglycemia
Change compared to usual baseline
Another view of relative hypoglycemia
Mortality and relative hypoglycemia in ICU patients(>30% fall b/w 2 consecutive blood gases)
After adjustment for illness severity
Frequency of relative hypoglycemia and risk of death
Insulin induced relative hypoglycemia and mortality
Rapid (<4hours) relative hypoglycemia and mortality
Where to from here?
• Evidence that glucose control matters (NICE-SUGAR)
• Evidence that hypoglycemia is injurious
• Evidence that relative hypoglycemia exists
• Evidence that it may also be bad
• Evidence that diabetics (esp. bad ones) are different and at
particular risk of relative hypoglycemia
• Evidence we can assess chronic glycemic control on
admission by HbA1c
• Evidence we can decrease relative hypoglycemia with
liberal glycemic control in diabetics
• Evidence that relative hypoglycemia is associated with
mortality in non-diabetic patients
• Further studies underway

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