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.