COMMENTARY

Hypoglycemia Advances: Just the 'Tip of the Iceberg'

Shivani Agarwal, MD, MPH

Disclosures

August 18, 2017

Editorial Collaboration

Medscape &

Hello. My name is Shivani Agarwal. I am a clinician researcher at the University of Pennsylvania and I specialize in diabetes care. I am here at the American Diabetes Association in San Diego, and I have some very exciting news to report.

Over the past few days, we have learned about many new and exciting treatments for hypoglycemia. As many of you may know, hypoglycemia is a very significant problem in people with type 2 diabetes who are on insulin treatment and in those who have type 1 diabetes. Not only is it a medical issue but it is also a quality-of-life issue for these patients and their families. There are many different scenarios where hypoglycemia can become really critical for patients and their families. Concerns about hypoglycemia can lead to loss of sleep and exercise.[1]

Formerly, we did not have a lot of treatments. We would say, "Eat some sugar if you feel low." If a patient is basically unconscious, we have glucagon which, in its current form, is a powder that you have to mix with a liquid and then deliver. It is lifesaving but not necessarily the most desirable treatment that we have.

Algorithms to Prevent Hypoglycemia

Now we have more options. One of the really exciting things that came out of this meeting is the ability for technology to preemptively target hypoglycemia. A lot of new pumps—"artificial pancreas" systems and current pumps—are already using these algorithms, which can predict whether a patient will go low at nighttime[2,3] or as related to exercise.[4,5,6] They actually can stop delivering insulin in response to that.

The data [strongly] suggest that even intermittent cessation of insulin will decrease the risk for hypoglycemia but not cause rebound hyperglycemia. The algorithms are getting better and better.

That is really exciting. The data are very compelling. The algorithms have been tested in all age groups and are pretty consistent.

New Glucagon Formulations

Because of its inability to remain in solution, glucagon has been a real bear to deliver. Two new liquid formulations of glucagon[7,8] in already pre-drawn syringes are being used for research purposes and will hopefully hit the market soon in many different doses. You can keep it in your purse, you can keep it by your bedside. Deliver the dose just like insulin, and it is very effective.

This is just the tip of the iceberg. We have a lot more to learn, but it's definitely a new year for treatments and advancements in hypoglycemia.

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