Management of Hypoglycemia in Adults with Type 1 Diabetes in Real-Life Condition

Introduction: Hypoglycemia is the most common acute complication in individuals with type 1 diabetes (T1D). Episodes of mild or moderate hypoglycemia should be treated in adults with a dose of around 15-20 g fast-acting carbohydrates. However, this self-treatment of hypoglycemia in real-life condition is not well documented. Objective: The aim of this study wasto determine the characteristics of hypoglycemia treatment in adults with T1D in a prospective study design. Methods: Individuals with T1D were advised to record information related to hypoglycemia episodes for a period of 14 days. Quantity and quality (including glycemic index [GI] and glycemic load) of carbohydrates consumed in every hypoglycemia episode and others factors related with hypoglycemia such as physical activity, fear of hypoglycemia, or hypoglycemia awareness were analyzed. Results: A total of 93 individuals (36.5 +/- 16.2 years old, BMI of 24.9 +/- 3.8 kg/m(2), diabetes duration of 14.9 +/- 10.4 years, and HbA1c levels of 7.3 +/- 0.8%) were included in the study. A total of 483 episodes of mild or moderate hypoglycemia were reported, which supposed on average 2.7 +/- 2.0 episodes a week. The quantity of carbohydrates consumed in all episodes of hypoglycemia was 25.9 +/- 9.2 g. GI of food consumed in all episodes of hypoglycemia was classified as low (53.9 +/- 8.3). Overtreatment of hypoglycemia, defined as ingestion of more than 20 g of carbohydrates, occurred in 50.3% of hypoglycemic episodes; even 22.3% of these episodes were treated with more than 30 g of carbohydrates. Fruit juice was the most popular option, chosen in almost 70% of the events. In addition, we observed other moderate or low GI foods such as milk, bread, cookies, and bakery products among the most consumed foods. Conclusion: A majority of the studied individuals with T1D does not manage hypoglycemia according to current American Diabetes Association guidelines, in most cases by overtreating, choosing foods with low glycemic effect, and not varying the dose of carbohydrates, depending on the physical activity performed.