China
Africa
Explore chapters and articles related to this topic
Hypoglycemia/Low Blood Sugar
Published in Charles Theisler, Adjuvant Medical Care, 2023
Hypoglycemia is not a disease in itself, but a condition characterized by an abnormally low level of blood glucose. That means a glucose level of 70 milligrams per deciliter (mg/dL) or less. Hypoglycemia is uncommon in patients not treated for diabetes and is most often related to medications that lower blood glucose levels in the treatment of diabetes mellitus. Other conditions such as alcoholism, severe sepsis, adrenal insufficiency, and panhypopituitarism,1 as well as diet and medications (e.g., quinine, propranolol, high doses of aspirin) can also cause hypoglycemia. As blood glucose levels fall, a variety of symptoms and signs may ensue, including hunger, sweating, pallor, shakiness, clumsiness, weakness, trouble talking, confusion, loss of consciousness, and seizures, coma, or death. In severe hypoglycemia, the patient is unable to care for himself and requires emergency medical care.
Pathophysiology of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Hypoglycemia that is not related to exogenous insulin therapy is uncommon. It is characterized by low plasma glucose levels, symptomatic stimulation of the sympathetic nervous system, and dysfunction of the central nervous system (CNS). Hypoglycemia can be caused by many drugs and disorders. Most often, symptomatic hypoglycemia is due to drugs used in the treatment of diabetes mellitus, including oral antihyperglycemics or insulin. When hypoglycemia occurs for other reasons, the body is often highly able to compensate. Acute hypoglycemia initially causes levels of glucagon and epinephrine to surge. Cortisol and growth hormone levels also sharply increase, which are important for recovery from extended hypoglycemia. The threshold for these hormones’ release is usually higher than that for hypoglycemic symptoms.
Endocrine Disorders
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Lisa Spence, Nana Adwoa Gletsu Miller, Tamara S. Hannon
While insulin therapy is important for prevention of hyperglycemia, a common and much-feared complication is hypoglycemia. Symptoms of hypoglycemia include with hunger, shakiness, perspiration, dizziness, lightheadedness, sleepiness, and confusion. To reduce the risk of hypoglycemia, guidelines recommend a practice of frequent monitoring of blood glucose. To mitigate the debilitating impacts of both hypo- and hyperglycemia, it is essential that treatment of T1D in children involves providing diabetes self-management education to the child and family, with support from a healthcare team of pediatric endocrinologists, dietitians, nurses, pharmacists, social workers, and psychologists for coping with issues associated with biology, mental health, family dynamics, as well as with the school and community.
Doege-Potter syndrome in a patient with a giant abdominal solitary fibrous tumor: a case report and review of the literature
Published in Acta Clinica Belgica, 2023
Joris Rötgens, Bruno Lapauw, Guy T’Sjoen
One should think about the possibility of a NICTH or Doege-Potter syndrome in any patient with hypoglycemia without clear etiology. The Endocrine Society Guidelines recommend a thorough investigation when Whipple’s triad is fulfilled [13]. From a practical point of view, the underlying causes of hypoglycemia can be divided into three major groups. First, hypoglycemia can be the result of glycemia-lowering medications (especially insulin and sulphonylurea) or due to the use of alcohol (blocking the hepatic gluconeogenesis which can cause hypoglycemia when combined with low carbohydrate intake). Second, associated diseases as sepsis (high glucose use), organ failure more specifically hepatic failure (diminution of gluconeogenesis and glycogenolysis) or renal insufficiency (less insulin clearance) and endocrine diseases such as cortisol- or GH-deficiency (less counter-regulatory activity) can cause hypoglycemia [2]. Third, after excluding previous pathologies, causes of endogenous hyperinsulinism (insulinoma, post-gastric bypass, presence of insulin autoantibodies) or an elevated insulin-like activity (NICTH/Doege-Potter syndrome) must be excluded. To distinguish these causes from each other it is necessary to draw a serum glucose level to confirm the hypoglycemia with simultaneous measurement of insulin, proinsulin, C-peptide and beta-hydroxybutyrate. When insulin, C-peptide and beta-hydroxybutyrate are all low, this suggests the presence of an agent mimicking insulin. In such cases, it is important to measure GH, IGF-I, IGF-II and when possible pro-IGF-II as well (Table 2) [6,14].
Predictors of cognitive and emotional symptoms 12 months after first-ever mild stroke
Published in Neuropsychological Rehabilitation, 2023
Georgios Vlachos, Hege Ihle-Hansen, Torgeir Bruun Wyller, Anne Brækhus, Margrete Mangset, Charlotta Hamre, Brynjar Fure
We found that having diabetes was a borderline significant predictor for cognitive impairment one year after stroke. A strong epidemiological association exists between diabetes mellitus and cognitive impairments (Gudala et al., 2013). The mechanisms behind this association may be related to glucose toxicity, insulin resistance and inflammation (Ninomiya, 2014), possibly leading to irreversible changes in deep, subcortical networks, explaining why improvements in glucose regulation often does not lead to a clinical improvement of cognitive functioning. In patients with stroke, diabetes is known to be a strong risk factor for cognitive impairment (Pendlebury & Rothwell, 2011), probably due to organic lesions resulting from subcortical small vessel disease or, in some cases, cortical lesions (Ninomiya, 2014). Still, there is evidence suggesting that both vascular (Qiu et al., 2005) and degenerative (Biessels & Despa, 2018) processes may contribute to cognitive decline in persons suffering from diabetes. In addition, recurrent hypoglycemia may produce permanent neurological damage leading to cognitive impairments (Lin & Sheu, 2013).
The role of sodium-glucose co-transporter 2 protein inhibitors in heart failure: more than an antidiabetic drug?
Published in Expert Opinion on Pharmacotherapy, 2022
Sugeevan Savarimuthu, Amer Harky
The use of SGLT2 inhibitors as with any medication can be associated with side effects and complications, which the clinician should be wary of when using this medication. Urinary tract infections (UTI) have been associated with SGLT2 inhibitors as the mechanism of action leads to glycosuria thus promoting bacterial growth. The US food and drug administration issued a warning about the risk of UTI and pyelonephritis with SGLT2 inhibitor use. The correlation between SGLT2 inhibitor and UTI has varied between trials with the VERTIS CV trial showing an increased association of UTI in patients with ertugliflozin compared to the placebo, whereas trials such as the CREDENCE trial did not find such a correlation. There is insufficient evidence on whether high risk individuals, such as those with abnormal urogenital anatomy, or immunosuppressed are at greater risk of UTI due to SGLT2 inhibitor use. Despite lack of clear-cut evidence those with recurrent or complicated UTI whilst on a SGLT2 inhibitor should consider whether to pursue with the medication or choose an alternative. Hypoglycemia can result in a life-threatening situation for patients especially those who lack hypoglycemia awareness. Antidiabetic medications that influence the action of insulin directly can produce the unwanted effect of hypoglycemia. Fortunately, the action of SGLT2 inhibitors alone do not interfere directly with insulin and so are not associated with profound hypoglycemia.