According to Dr. Nguyen Quang Bay - Head of the Department of Endocrinology - Diabetes, Bach Mai Hospital, blood sugar control is the foundation in the treatment of diabetes, helping to reduce the risk of eye, kidney, nerve damage and many other dangerous complications in the long term. However, few people know that in some patients with very high blood sugar levels for a long time, rapid hypoglycemia can temporarily make some complications worse.
This is a "early deterioration" phenomenon that has been recorded in medical literature for more than 40 years. Although it sounds paradoxical, this does not mean that patients should delay treatment, but blood sugar needs to be controlled at an appropriate pace and closely monitored in the early stages.
Not all diabetic patients experience "early deterioration". The risk is often concentrated in people with very high and prolonged blood sugar spikes before treatment.
Factors that increase the risk include very high initial HbA1c (blood glucose test), long-term illness, and existing microvascular complications such as retinal disease, neurological disease, or kidney disease.
In addition, lowering HbA1c too quickly is considered the most important risk factor. It is noteworthy that it is not low HbA1c causing complications, but the sudden change from a very high level to near normal level that increases the risk.
This phenomenon can also occur when blood sugar control is too active with medication, after weight loss surgery, pancreatic transplantation, or measures to reduce blood sugar rapidly. This shows that the main cause is related to the rate of blood sugar improvement, not the treatment drug itself.
According to Dr. Nguyen Quang Bay, to date, there is no single mechanism to explain this phenomenon. The hypothesis supported by many experts is the "energy crisis" of the nerve. When blood sugar increases for a long time, the nerve has adapted to oxygen deficiency and reduced irrigation. If blood sugar drops too quickly, the energy source is suddenly cut off while circulation has not yet recovered, making nerve fibers easily damaged, causing pain and neurological disorders. Some other hypotheses also suggest that anemia that nourishes nerves, regenerates nerve fibers and changes osmotic pressure may contribute to making retinal and neurological diseases worse.
This phenomenon is not a reason to delay blood sugar control, because the long-term benefit in preventing complications has been proven.
