Hypoglycémie diabétique

Hypoglycémie diabétique

Données clés

Classification et ressources externes

CISP-2	T87
CIM-9	250.8

Mise en garde médicale

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L'hypoglycémie diabétique est une hypoglycémie (donc un glucose sanguin abaissé) qui se produit chez un patient diabétique. C'est l'un des types d'hypoglycémie les plus communs observés dans un service d'urgence ou un hôpital. En général, elle se produit lorsqu'un traitement hypoglycémiant (c'est-à-dire visant à abaisser la glycémie) s'avère excessif et entraîne une chute de la glycémie en dessous de sa limite inférieure.

À titre indicatif, l'hypoglycémie chez le diabétique est definie par une glycémie inférieure à 0,7 g·l^-1[1].

L'hypoglycémie est une urgence vitale, elle ne passera jamais seule. Une hypoglycémie doit être traitée par un resucrage, en sucre rapide (pastilles de glucose, morceaux de sucre, de dextrose) complété par l'absorption de sucre lent (pain) pour stabiliser la glycémie. Le dextrose est idéal pour le resucrage car son assimilation est optimale^{[réf. souhaitée]}.

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Diabetic hypoglycemia can be mild, recognized easily by the patient, and reversed with a small amount of carbohydrates eaten or drunk, or it may be severe enough to cause unconsciousness requiring intravenous dextrose or an injection of glucagon. Severe hypoglycemic unconsciousness is one form of diabetic coma. A common medical definition of severe hypoglycemia is "hypoglycemia severe enough that the person needs assistance in dealing with it."

Diabetic hypoglycemia can occur in any person with diabetes who takes any medicine to lower his blood glucose, but severe hypoglycemia occurs most often in people with type 1 diabetes who take insulin. Hypoglycemia can also be caused by sulfonylureas in people with type 2 diabetes. Severe hypoglycemia rarely, if ever, occurs in people with diabetes treated only with diet, exercise, or insulin sensitizers.

Symptoms of diabetic hypoglycemia are those of hypoglycemia: neuroglycopenic, adrenergic, and abdominal. Symptoms and effects can be mild, moderate or severe, depending on how low the glucose falls and a variety of other factors. It is rare but possible for diabetic hypoglycemia to result in brain damage or death.

In North America a mild episode of diabetic hypoglycemia is often termed a "low" or an "insulin reaction," and in Europe a "hypo". A severe episode is sometimes referred to as "insulin shock".

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Traitement

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The blood glucose can be raised to normal within minutes with 15-20 grams of carbohydrate. It can be taken as food or drink if the person is conscious and able to swallow. This amount of carbohydrate is contained in about 3-4 ounces (100-120 ml) of orange, apple, or grape juice, about 4-5 ounces (120-150 ml) of regular (non-diet) soda), about one slice of bread, about 4 crackers, or about 1 serving of most starchy foods. Starch is quickly digested to glucose, but adding fat or protein retards digestion. Symptoms should begin to improve within 5 minutes, though full recovery may take 10-20 minutes. Overeating does not speed recovery and will simply produce hyperglycemia afterwards.

If a person is suffering such severe effects of hypoglycemia that they cannot (due to combativeness) or should not (due to seizures or unconsciousness) be given anything by mouth, glucose can be given by intravenous infusion or the blood glucose can be rapidly raised by an injection of glucagon. Glucose is available for intravenous infusion in various concentrations. The highest is 50% dextrose (about 18 grams of glucose in 40 ml of fluid), but this should be given carefully as it is damaging to tissue if the infusion leaks from the vein.

Glucagon is a hormone that rapidly counters the metabolic effects of insulin in the liver, causing glycogenolysis and release of glucose into the blood. It can raise the glucose by 30-100 mg/dl within minutes in any form of hypoglycemia caused by insulin excess (including all types of diabetic hypoglycemia). It comes in tiny vials containing 1 mg, which is a standard adult dose. The glucagon in the vial is a lyophilized pellet, which must be reconstituted with 1 ml of sterile water, included in the "kit". In the widely used Lilly Emergency Kit, the water is contained in a syringe with a large needle for intramuscular injection and must be injected into the vial with the pellet of glucagon before being injected. Glucagon works if given subcutaneously, but absorption and recovery are faster if it is injected deep into a muscle (usually the middle of the outside of the thigh). It has an even more rapid effect when given intravenously but this is rarely practicable. Side effects of glucagon can include nausea and headache, but these can also occur after severe hypoglycemia even when glucagon is not used. There are no serious risks to glucagon use, and it can usually produce a faster recovery than calling for paramedics and waiting for them to start an intravenous line to give dextrose.

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Notes et références

1. « Item 206 – Hypoglycémie », sur www.sfendocrino.org Société française d'endocrinologie (consulté le 29 août 2014)

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