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Inicio Endocrinología y Nutrición Fisiopatología de la hipoglucemia en la diabetes mellitus
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Vol. 49. Núm. 5.
Páginas 140-144 (mayo 2002)
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Vol. 49. Núm. 5.
Páginas 140-144 (mayo 2002)
Acceso a texto completo
Fisiopatología de la hipoglucemia en la diabetes mellitus
Physiopathology of hypoglycemia in diabetes mellitus
Visitas
153654
A. Rovira
Autor para correspondencia
arovira@fjd.es

Correspondencia: Dra. A. Rovira. Servicio de Endocrinología. Fundación Jiménez Díaz. Avda. Reyes Católicos, 2. 28040 Madrid.
Jefe Asociado del Servicio de Endocrinología. Fundación Jiménez Díaz. Madrid
Este artículo ha recibido
Información del artículo

Los pacientes con diabetes mellitus tipo 1 necesitan un tratamiento intensivo con insulina para evitar el desarrollo o la evolución de las complicaciones microangiopáticas; sin embargo, este tratamiento lleva parejo un alto riesgo de hipoglucemia que limita, en la mayoría de los casos, la consecución de un estricto control glucémico. El organismo dispone de una serie de medidas de respuesta ante la disminución las concentraciones circulantes de glucosa con objeto de mantener un adecuado suministro de glucosa al cerebro. Estas respuestas se inician con la inhibición de la secreción de insulina, que se sigue inmediatamente de un aumento de la secreción de glucagón. A continuación, se produce la secreción de adrenalina y noradrenalina y, más tardíamente, se produce un aumento de la secreción de la hormona del crecimiento y de cortisol. En los pacientes con diabetes mellitus tipo 1 de larga duración, con antecedentes de hipoglucemias frecuentes y con hipoglucemias no reconocidas, la secreción de hormonas contrarreguladoras se produce a concentraciones circulantes de glucosa más bajas que en sujetos no diabéticos. Estos pacientes pierden los síntomas simpáticos y parasimpáticos que les permiten tomar medidas apropiadas para corregir la hipoglucemia. La ausencia de reconocimiento de la hipoglucemia constituye no sólo un grave riesgo para la vida del paciente diabético, sino también una situación que compromete seriamente su calidad de vida. Las hipoglucemias inadvertidas pueden revertir evitando cuidadosamente la aparición de nuevas hipoglucemias. La prevención de la hipoglucemia requiere diferentes estrategias que incluyen la educación del paciente, la monitorización frecuente de la glucemia y la modificación de las pautas de insulina.

Palabras clave:
Hipoglucemia
Diabetes mellitus tipo 1
Adrenalina
Noradrenalina
Glucagón
Insulina

Patients with type 1 diabetes require intensive insulin therapy to prevent the development or progression of microangiopathic complications. However, this treatment has a high risk of hypoglycemia, which limits strict glycemic regulation. There are several reactions against decreased circulating glucose levels that are directed to supplying adequate glucose to the brain. The initial factor involved in hypoglycemia counter-regulation is suppression of insulin secretion, immediately followed by an increase in glucagon release. These responses are followed by adrenaline and noradrenaline secretion, and subsequently by an increase in growth hormone and cortisol release. In patients with longstanding type 1 diabetes and previous frequent hypoglycemic episodes with hypoglycemic unawareness, counter-regulatory hormone secretion occurs at lower glycemic levels than in healthy subjects. These patients lose the sympathetic and parasympathetic symptoms that allow them to take appropriate corrective measures. Hypoglycemic unawareness not only presents a serious risk to the patient's life, but also causes quality of life to deteriorate. Hypoglycemic unawareness can be reversed by carefully preventing new episodes. Prevention of hypoglycemia requires various strategies, including patient education, frequent glucose monitoring and changes in insulin regimen.

Key words:
Hypoglycemia
Type 1 diabetes mellitus
Adrenaline
Noradrenaline
Glucagon
Insulin
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Copyright © 2001. Sociedad Española de Endocrinología y Nutrición
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