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A Journal on Internal Medicine

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Panminerva Medica 2000 March;42(1):23-6


language: English

Does holiday hypoglycaemia exist?

Guagnano M. T., Pace-Palitti V., Formisano S., Della Loggia F., D’Anchino M., Della Vecchia R., Merlitti D., Sensi S.

From the Internal Medicine, Department of Medicine and Aging University of Chieti, Italy

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Background. To deter­mine ­whether an exces­sive, pro­longed and, ­above all, ­unusual phys­ical exer­tion ­could be asso­ciated ­with epi­sodes of ­mild hypo­gly­caemia in non-­insulin-depen­dent diabetes mellitus (­NIDDM) ­patients ­treated ­with gli­ben­cla­mide.
Methods. Experimental ­design: 11 ­months of obser­va­tion ­with ret­ro­spec­tive anal­ysis of ­patient per­sonal ­diaries to deter­mine the hypo­gly­caemic ­risk. Setting: Diabetic Unit — Department of Medicine and Aging — Chieti University School of Medicine.
Patients: We ­enrolled 340 ­NIDDM out­pa­tients ­adjusted for sex, age, ­body ­mass ­index, ­alcohol ­intake and ­oral treat­ment reg­imen ­with gli­ben­cla­mide. Patients ­were ­tested ­monthly for cir­ca­dian ­blood glu­cose pro­files and gly­cos­y­lated hemo­globin. Mild hypo­gly­caemia was ­defined on the ­basis of ­blood glu­cose ­values <2.8 ­mmol/l asso­ciated ­with ­mild auto­nomic symp­toms, ­without ­requiring ­external assis­tance. Each dia­betic ­patient ­filled a per­sonal ­diary indi­cating the ­therapy reg­imen and the char­ac­ter­is­tics of even­tual hypo­gly­caemic epi­sodes occur­ring ­during the obser­va­tion ­period.
Results. 21.8% of ­NIDDM ­patients expe­ri­enced one or two epi­sodes of ­mild hypo­gly­caemia ­during the obser­va­tion ­period. The anal­ysis of the ­patients’ ­diaries ­showed ­that 60% of the hypo­gly­caemic epi­sodes was asso­ciated ­with exces­sive, pro­longed and unex­pected phys­ical exer­tions. Within ­this ­group, ­about 70% of the epi­sodes ­occurred ­during a hol­iday (“hol­iday hypo­gly­caemia”). After ana­lyzing the ­socio-dem­o­graphic and clin­ical char­ac­ter­is­tics of the dia­betic ­patients ­reporting hypo­gly­caemic ­events, we ­found a ­higher ­risk for “hol­iday hypo­gly­caemia” in ­patients ­with a ­lower edu­ca­tional ­level, ­with a sed­en­tary occu­pa­tion or ­among the ex-­farmers.
Conclusions. As ­resulted in the ­present ­study, unex­pected phys­ical exer­tions may rep­re­sent a rel­e­vant ­cause of ­mild hypo­gly­caemia in dia­betic ­patients ­receiving ­oral anti­di­a­betic ­therapy. However, ­this hypo­gly­caemic ­cause may ­have ­been under­es­ti­mated in the lit­er­a­ture. Educational pro­grams con­ducted by gen­eral prac­ti­tioners or dia­be­tol­o­gists ­could be ­useful for the ­patients in ­reducing the ­number of ­mild hypo­gly­caemic epi­sodes.

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