Does hypothermia cause hypoglycemia (low blood sugar) or vice versa?

From the Guidelines

Hypothermia is more likely to cause hyperglycemia rather than hypoglycemia, as it decreases insulin sensitivity and insulin secretion, according to the 2015 guidelines for post-resuscitation care by the European Resuscitation Council and European Society of Intensive Care Medicine 1. The relationship between hypothermia and glucose metabolism is complex, and hypothermia can lead to various metabolic changes.

• Hypothermia decreases insulin sensitivity and insulin secretion, which can cause hyperglycemia, as stated in the guidelines 1.
• The body's response to hypothermia includes shivering, which increases metabolic and heat production, but this does not necessarily lead to hypoglycemia.
• However, it is essential to consider that severe hypoglycemia can occasionally contribute to hypothermia, as low blood sugar impairs the body's ability to maintain normal thermoregulation.
• The guidelines highlight the importance of managing the physiological effects of hypothermia, including hyperglycemia, which may require treatment with insulin 1.
• It is crucial to monitor patients with hypothermia for signs of hyperglycemia and hypoglycemia, as both conditions can have significant consequences if left untreated.
• In clinical practice, it is essential to prioritize the management of hyperglycemia in patients with hypothermia, as it is a more likely consequence of hypothermia, based on the available evidence 1.

From the Research

Relationship Between Hypothermia and Hypoglycemia

• Hypothermia can cause hyperglycemia due to decreased insulin sensitivity and secretion, as seen in patients undergoing therapeutic hypothermia 2, 3.
• However, hypoglycemia can also occur during rewarming, emphasizing the need for close monitoring of blood glucose levels 4, 2.
• Severe hypoglycemia can lead to hypothermia, as evidenced by a study showing that hypothermia is a frequent sign of severe hypoglycemia in patients with diabetes 5.

Glycemic Control During Hypothermia

• Therapeutic hypothermia is associated with increased blood glucose variability, hyperglycemia, and hypoglycemia 2, 6.
• Insulin therapy is often required to manage hyperglycemia during therapeutic hypothermia, with higher insulin requirements during the cooling phase 2, 6.
• Close monitoring of blood glucose levels is crucial to prevent hyperglycemia and hypoglycemia during therapeutic hypothermia 4, 2, 6.

Clinical Implications

• Hypothermia and hypoglycemia can have significant clinical implications, including increased morbidity and mortality 5, 6.
• Understanding the relationship between hypothermia and hypoglycemia is essential for providing optimal care to patients at risk of these conditions 4, 5, 2, 6, 3.