Emil Martinka, Michaela Mišániková
Iatrogenic hypoglycaemia represents a serious medical problem. This phenomenon not only limits intensification of
glycaemic control, but it is also related to increased risk of cardiovascular and overall morbidity and mortality. It is
frequently an unfavourable effect frequency of which is growing with glycaemic control intensification as well as with
progression of therapeutic steps. The question of iatrogenic hypoglycaemia as an unfavourable effect and potent cardiovascular
and also overall risk is a very frequently discussed theme. But these issues need to be observed from different
angles of view. Hypoglycaemia, especially severe, undoubtedly presents a serious risk factor, which increases cardiovascular
(CV) and overall mortality. In case of CV mortality it is especially induction of ischeamia and fatal heart arrhythmia.
Injuries, falls and neurological causes (coma, spasms, cognitive dysfunctions) contribute to the overall mortality. But
mortality risk of hypoglycaemia does not depend on the intensity of glycaemic control and reached level of compensation.
A very important question at risk evaluation of hypoglycaemia is "terrain" of the patient, with the need of individualisation
at decisions on goals and ways of the glycaemic control. Inclination to hypoglycaemia in individual patients
at the same treatment and reached values of the hypoglycaemic control varies and according to several authors it identifies
some "more vulnerable, or more more ill" patients with comorbidity (hepatic, renal, endocrinologic or oncological)
and more unstable protective systems, which may itself increase cardiovascular and also overall mortality. So hypoglycaemia
represents not only a risk factor but also a marker identifying risk patients. Even if the relation between
hypoglycaemia and increased mortality stays the subject of discussions, therapeutic procedures with a low risk of hypoglycaemia
and verified cardiovascular and oncological safety.