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Neurological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
The level of consciousness is assessed using the Glasgow Coma Scale. Where coma was preceded by focal neurological symptoms (e.g. focal seizures, hemiparesis), there is usually a focal cause (e.g. subdural haematoma), but hypoglycaemia can cause focal disturbances which resolve when the blood glucose is normalized. A focal cause is also more likely where there are asymmetrical pupils or conjugate deviation of the eyes, or asymmetry of the oculocephalic reflex, the caloric responses, the limb response to pain or the plantar response. Common ‘medical’ causes of coma include drugs and alcohol intoxication and diabetic hypoglycaemia.
The practical management of hormonal treatment in adults with gender dysphoria
Published in James Barrett, Transsexual and Other Disorders of Gender Identity, 2017
The management of PCOS depends on the patient’s presenting complaint. In all cases, however, weight reduction can lead to a significant improvement in the clinical condition of the patient, with a decrease in androgen production and a return of ovulation. The insulin resistance is treated with the biguanide drug metformin. This increases the peripheral tissue sensitivity to insulin, and also decreases appetite leading to weight reduction. Doses of 500 mg once daily up to 850 mg three times daily are used. Even in patients who are not diabetic, hypoglycaemia does not occur. The major side-effect of the medication is gastrointestinal upset, which can limit its effectiveness. The hepatic lipase inhibitor orlistat is also effective in PCOS, producing its effects by weight loss. On treatment with metformin 89% have a return of ovulation.20
Evaluating dasiglucagon as a treatment option for hypoglycemia in diabetes
Published in Expert Opinion on Pharmacotherapy, 2020
Shujuan Li, Ying Hu, Xueying Tan, Dongwei Wang, Jingbo Hu, Ping Zou, Li Wang
Diabetic hypoglycemia, a low blood glucose level occurring in diabetic patients, is a dangerous and unresolved complication during diabetes therapy [1]. Recommendations from the American Diabetes Association (ADA) regarding the classification of hypoglycemia consider a measurable blood glucose concentration (BGC) <70 mg/dL (3.9 mmol/L) but ≥54 mg/dL (3.0 mmol/L) as level 1 hypoglycemia. A threshold value of <54 mg/dL (3.0 mmol/L) is defined as level 2 hypoglycemia, representing a level at which neuroglycopenic symptoms begin to occur and the urgent resolution for hypoglycemia is required. Level 3 hypoglycemia (severe hypoglycemia) is independent of measured BGC and requires external assistance for recovery due to the altered mental and/or physical function [2]. Diabetic hypoglycemia is a common concern for diabetic patients receiving sulfonylurea or glinides treatment, while especially for insulin-dependent patients [3,4]. All patients with type 1 diabetes mellitus (T1DM) and ~30% of patients with type 2 diabetes depend on insulin for combating hyperglycemia. However, multiple daily administration of exogenous insulin potentially results in severe hypoglycemia, which could be characterized by brain function impairment-related seizures, loss of consciousness, and even death if left untreated [5]. It has been a common concern that 30–40% of patients with T1DM undergo one to three episodes of severe hypoglycemia averagely per year, while about one-third that number for insulin-treated patients with type 2 diabetes [3]. Therefore, exploring an effective treatment and management option for hypoglycemia in diabetes is in high demand nowadays.