IJCM  Vol.3 No.7 A , December 2012
Causes of Fasting-Evoked en Route Hypoglycemia in Diabetes (FEEHD): A Case Series Study
ABSTRACT

Background: A recent study reported that some patients with diabetes who fast overnight for laboratory tests are at risk of developing hypoglycemia, which could occur while patients are in risky situations which could result in harm to patients or others. Due to limitation in study design of the aforementioned study, the causes of hypoglycemia could not be elucidated. Objective: To better understand fasting-evoked en route hypoglycemia in diabetes (FEEHD), a recently recognized overlooked safety problem in diabetes management. Methods and Patients: A recent study reported that some patients with diabetes who fast overnight for laboratory tests are at risk of developing hypoglycemia, which could occur while patients are in risky situations which could result in harm to patients or others. Due to limitation in study design of the aforementioned study, the causes of hypoglycemia could not be elucidated. We undertook this retrospective case series study, which enrolled 4 consecutive cases of fasting hypoglycemia in patients with diabetes who were on diverse antidiabetic medications. The study duration was June 1, 2010 to June 1, 2012. Results: The 4 cases (3 women, 1 man), with either type 1 or type 2 diabetes, revealed multiple defects in either the patients’ knowledge and education regarding preparation for lab tests requiring fasting. The degree of hypoglycemia ranged from mild (65 mg/dl) to severe (31 mg/dl), and the events were either mildly symptomatic or asymptomatic. The possible causes of, and contributing factors to hypoglycemia are discussed, and recommendations for preventive measures are provided. Conclusion: Some patients with diabetes who fast for lab tests are at risk of hypoglycemia, and there seems to be an overall lack of proper education of patients with diabetes about this form of hypoglycemia. This overlooked problem can be prevented by proper education and preparation.


Cite this paper
Aldasouqi, S. , Gossain, V. , Hebdon, M. , Reddy, A. , Goldman, J. , Ansar, S. and Bhavsar, B. (2012) Causes of Fasting-Evoked en Route Hypoglycemia in Diabetes (FEEHD): A Case Series Study. International Journal of Clinical Medicine, 3, 751-757. doi: 10.4236/ijcm.2012.37A132.
References
[1]   The American Diabetes Association Workgroup on Hypoglycemia, “Defining and Reporting Hypoglycemia in diabetes: A Report from the American Diabetes Association Workgroup on Hypoglycemia,” Diabetes Care, Vol. 28, No. 5, 2005, pp. 1245-1249. doi:10.2337/diacare.28.5.1245

[2]   V. Wiwanitkit, “Case of Sudden Death in Venipuncture Clinic,” Phlebotomy, Vol. 19, No. 4, 2004, pp. 193. doi:10.1258/0268355042554993

[3]   V. Wiwanitkit, “A Problematic Case Due to Blood Collection for Fasting Plasma Glucose Assessment,” Shiraz E Medical Journal, Vol. 7, No. 3, 2006, p. 1.

[4]   S. Aldasouqi, A. Sheikh, P. Klosterman, S. Kniested, L. Schubert, R. Danker and M. Austin, “Hypoglycemia in Patients with Diabetes on Antidiabetic Medications Who Fast for Laboratory Tests,” Diabetes Care, Vol. 34, No. 5, 2011, p. e52. doi:10.2337/dc10-2402

[5]   S. Aldasouqi, A. Sheikh, P. Klosterman, S. Kniested, L. Schubert, R. Danker, M. Austin and M. Grajower, “Hypoglycemia While Fasting for Morning Blood Tests: A Follow up of the Cape Girardeau Hypoglycemia en Route Prevention Program,” Proceedings of the Annual Meeting of the American Association of Clinical Endocrinologists, Philadelphia, 23-27 May 2012.

[6]   B. Bouton, “Patients with Diabetes Lack Knowledge about Hypoglycemia,” Medscape Website http://www.medscape.com/viewarticle/740881

[7]   American Diabetes Association, “Standards of Care in Diabetes—2011: Hypoglycemia,” Diabetes Care, Vol. 34, Suppl. 1, 2011, pp. S25-S26.

[8]   American Association of Diabetes Educators, “The Art and Science of Diabetes Self-Management Education: A Desk Reference for Healthcare Professionals,” In: C. Mensing, Ed. American Association of Diabetes Educators, Chicago, 2006.

[9]   S. Degogo-Jack and K. Alberti, “Management of Diabetes Mellitus in Surgical Patients,” Diabetes Spectrum, Vol. 15, No. 1, 2002, pp. 44-48. doi:10.2337/diaspect.15.1.44

[10]   M. Al-Arouj, R. Bouguerra, J. Buse, et al., “Recommendations for Management of Diabetes during Ramadan,” Diabetes Care, Vol. 28, No. 9, 2005, pp. 2305-2311. doi:10.2337/diacare.28.9.2305

[11]   M. M. Grajower, “Management of Diabetes Mellitus on Yom Kippur and Other Jewish Fast Days,” Endocrine Practice, Vol. 14, No. 3, 2008, pp. 305-311.

[12]   M. Korbonits, D. Blaine, M. Elia and J. Powel-Tuck, “Refeeding David Blaine—Studies after a 44 Day-Fast,” New England Journal of Medicine, Vol. 353, No. 21, 2005, pp. 2306-2307. doi:10.1056/NEJM200511243532124

[13]   J. Reiter, I. D. Wexler, N. Shehadeh, A. Tzurt and D. Zangen, “Type 1 Diabetes and Prolonged Fasting,” Diabetic Medicine, Vol. 24, No. 4, 2007, pp. 436-439. doi:10.1111/j.1464-5491.2007.02098.x

[14]   M. Grajower, “24-Hour Fasting with Diabetes: Guide to Physicians Advising Patients on Medication Adjustments Prior to Religious Observances (or Outpatient Surgical Procedures),” Diabetes/Metabolism Research and Reviews, Vol. 27, No. 5, 2011, pp. 413-418. doi:10.1002/dmrr.1169

[15]   M. Al-Arouj, S. Assaad-Khalil, J. Buse, et al., “Recommendations for Management of Diabetes during Ramadan: Update 2010,” Diabetes Care, Vol. 33, No. 8, 2010, pp. 1895-1902. doi:10.2337/dc10-0896

[16]   J. Hoeks, N. A. van Herpen, M. Mensink, E. Moonen-Kornips, D. van Beurden, M. K. Hesselink and P. Schrauwen, “Prolonged Fasting Identifies Skeletal Muscle Mitochondrial Dysfunction as Consequence Rather than Cause of Human Insulin Resistance,” Diabetes, Vol. 59, No. 9, 2010, pp. 2117-2125. doi:10.2337/db10-0519

[17]   M. Fowler, “The Diabetes Treatment Trap: Hypoglycemia,” Clinical Diabetes, Vol. 29, No. 1, 2011, pp. 36-39. doi:10.2337/diaclin.29.1.36

[18]   G. Mucha, S. Merkel, W. Thomas and J. Bantle, “Fasting and Insulin Glargine in Individuals with Type 1 Diabetes,” Diabetes Care, Vol. 27, No. 5, 2004, pp. 1209-1210. doi:10.2337/diacare.27.5.1209

 
 
Top