Unexplained Hypoglycaemia and Large Glycaemic Variability: Skin Lipohypertrophy as a Predictive Sign
The main goal of diabetes treatment is to maintain an adequate
metabolic control in order to prevent or delay disease complications.
However, when too strong efforts are made to keep glycated haemoglobin
within target levels, patients often are at a high risk for hypoglycaemia.
Hypoglycaemic episodes, especially severe ones, have a relevant clinical, social
and economic impact. From a clinical standpoint, they are characterized by several
symptoms ranging from general discomfort to seizures and coma eventually
resulting into either sudden cardiac arrhythmic death or lethal brain damage due to long-lasting
cerebral tissue glucose deprivation.
Repeated severe Hypos are associated with a higher cardiovascular risk, and dementia.
Even mild symptomatic hypoglycaemia is associated with an increased risk of cardiovascular
events and all-cause hospitalization/mortality Moreover, from a social point of view, several studies
suggest that Hypos may disrupt quality of life (QoL) in terms of driving efficiency,
work performance and recreational pursuits12 and thereby negatively affect patient’s
mood and health perception.
In addition, Hypos are by far the strongest factors hindering metabolic control in insulin-treated
patients as long-lasting hyperglycaemia invariably follows Hypos due both to rebound
counter-regulatory hormone reaction and to previous frightening experiences causing excessive
corrective behaviour and poor adherence to therapy. As a consequence of that high
glucose variability (GV) is also often observed.
Iatrogenic causes explain nearly all Hypos in people with T1DM. Predictable triggers,
as well as, defective glucose counter-regulation and established hypoglycaemia-associated
autonomic failure have been extensively described.
Diabetes Res Open J. 2016; 2(1): 24- 32. doi: 10.17140/DROJ-2-126
