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Factors contributing to hypoglycemia among patient with diabetes presenting with symptomatic hypoglycemia to a tertiary care centre of northern Sri Lanka

Prevalence of hypoglycemia is in increasing trend among diabetic patients especially when a stringent glycemic control is warranted. This study analyzes both traditional and drug related precipitating factors and the knowledge regarding hypoglycemia among diabetic patients presented with symptomatic hypoglycemia to a tertiary hospital in Northern Sri Lanka. It was a descriptive cross-sectional study. All adult diabetic patients who were admitted with symptomatic hypoglycemia were recruited (n=62). Majority (93.5%) of them were having type 2 diabetes mellitus (n=58) and 2/3 had evidence of nephropathy. Majority presented with their very first episode (68%). Twenty-six patients were on Insulin based regime and 29 were on oral hypoglycaemic drugs which contains a sulphonylurea. Among the 7 patients who were on metformin monotherapy all except one had established nephropathy. It was found that 7 patients with renal impairment who were on gliclazide monotherapy developed hypoglycemia. Apart from the drugs, missed meals (52%), concurrent illness (46%), recent hospital stays (25%), recent escalation in medication (20%) also contributed for the hypoglycemic events in these patients. Even though majority of patients had good knowledge on first aid measures only a fraction of them have attempted it. None of the patients were aware about glucagon home injection. Seventy seven percentage of patients were knowledgeable about the devastating complications of prolonged hypoglycemia while only one third was aware that warning signs can be absent in chronic diabetes patients. Insulin and sulphonylureas are the most potent drugs to cause hypoglycemia, but metformin also can potentiate it when prescribed to patients with nephropathy. Contrary to popular belief, gliclazide is not always safe in renal impairment and should be used with caution.