Hypoglykämien bei Diabetes mellitus: häufig und gefährlich

ZUSAMMENFASSUNG

Schwere Hypoglykämien führen häufig zu Verletzungen und sind mit einer mehr als 2-fach erhöhten kardiovaskulären Mortalität und Morbidität assoziiert. Hauptrisikofaktoren für Hypoglykämien bei Typ-1-Diabetes sind Störungen der Hypoglykämie-Wahrnehmung bzw. rekurrente Hypoglykämien, während bei Typ-2-Diabetes komplexe geriatrische Multimorbidität und kognitive Einschränkungen dominieren. Individuelle (Re-)Schulungen der Patienten bilden die Grundlage der Prävention. Therapieziele sollten unter Wertung des Patientenwunsches, der Komorbiditäten, des Hypoglykämierisikos, der Lebenserwartung u.a. individuell festgelegt werden. Bei Typ-2-Diabetes und Hypoglykämie-Vulnerabilität sind Antidiabetika ohne intrinsisches Hypoglykämierisiko (DPP-4-Hemmer, GLP-1-Analoga, SGLT-2-Hemmer) in der Zweitlinien-Therapie nach Metformin zu bevorzugen. Moderne CGM-Technologien tragen dazu bei, insbesondere gefährliche nächtliche Hypoglykämien zu reduzieren und die Hypoglykämie-Wahrnehmung zu verbessern. Auch CSII und wahrscheinlich der Einsatz moderner Basalinsulinanaloga senken das Hypoglykämierisiko bei Typ-1- bzw. Typ-2-Diabetes. Die simultane Transplantation von Pankreas und Niere, die isolierte Pankreastransplantation und Inseltransplantation führen nicht nur zur (temporären) Insulinunabhängigkeit, sondern vermeiden auch Hypoglykämien. Die primäre Therapie bei bewusstseinsgestörten Patienten mit schwerer Hypoglykämie besteht in der streng intravenösen Gabe von 50 ml 40 %iger Glukose als Bolus. Alternativ kann die Gabe von 1 mg Glukagon intramuskulär erfolgen. Ältere komorbide oder verletzte Diabetespatienten, Sulfonylharnstoff-Hypoglykämien und Hypoglykämien unter Alkoholkonsum oder Analgetika-/Sedativa-Medikation bedürfen obligat der stationären Überwachung.

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