- Acute complications of diabetes
Ian N. Scobie in Atlas of Diabetes Mellitus, 2006
Hypoglycemia is the greatest fear of patients treated with insulin. Hypoglycemia in patients with type 1 diabetes is a major source of disruption to their lives. It also occurs in patients treated with sulfonylureas, although to a lesser extent. Over 30% of insulintreated diabetic patients experience hypoglycemic coma at least once in their lives, and approximately 3% experience frequent and severe episodes. In the Diabetes Control and Complications Trial, the incidence of severe hypoglycemia was much greater and was approximately three times higher in the intensively treated group. Severe hypoglycemia occurred more often during sleep.The main causes are excessive doses of insulin or sulfonylureas, inadequate or delayed ingestion of food and sudden or prolonged exercise, although such factors caused only a minority of episodes of severe hypoglycemia in the trial.
Carnitine transporter deficiency
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop in Atlas of Inherited Metabolic Diseases, 2020
Hypoketotic hypoglycemia, seizures, vomiting, lethargy progressive to coma; cardiomyopathy; chronic muscle weakness; carnitine deficiency in plasma and muscle, and increased excretion of free carnitine in urine; defective transport of carnitine into cultured fibroblasts and mutations in the SLC22A5 gene which codes for the sodium ion-dependent carnitine transporter organic cation transporter. The inborn errors of fatty acid oxidation, including carnitine transporter deficiency, represent a relatively recently recognized area of human disease. The rate of discovery of distinct disorders has increased rapidly since the discovery of medium-chain acyl CoA dehydrogenase deficiency in 1982. The classic, and frequently the initial presentation of carnitine transporter deficiency, is hypoketotic hypoglycemia, as in most disorders of fatty acid oxidation. Clinical chemistry in the acute hypoketotic episode is also consistent with Reye syndrome, with hyperammonemia and increased levels of transaminases.
- Diabetes and surgery
Ian N. Scobie in Atlas of Diabetes Mellitus, 2006
It is well recognized, by both patients themselves and their usual advisors, that the treatment of diabetes in hospitalized diabetic patients is often suboptimal. A lack of knowledge of current treatment strategies and lack of familiarity with newer insulins, pen devices and newer hypoglycemic agents by ward staff contributes to substandard care, but can be overcome by the development, distribution and promotion of good treatment protocols, devised by the diabetic team to cover common situations. Many hospitals have now created in-patient diabetic specialist nurses to facilitate this with back-up from the diabetologist to help with more difficult or unusual cases. This is all the more important as many patients undergoing surgery will have diabetes and the metabolic stress of surgical procedures may lead to adverse outcomes if not properly managed. Diabetic patients undergoing surgery are at special risk of hyperglycemia and ketosis, hypoglycemia, perioperative complications such as wound infection, and iatrogenic problems of blood glucose control.
Incidence and Risk Factors Associated with Outpatient Hypoglycemia in Patients with Type 2 Diabetes and Chronic Kidney Disease: A Nationwide Study
Published in Endocrine Research, 2020
Wisit Kaewput, Charat Thongprayoon, Ram Rangsin, Tarun Bathini, Aldo Torres-Ortiz, Michael A. Mao, Wisit Cheungpasitporn
ABSTRACT Background Chronic kidney disease and hypoglycemia are common complications in individuals with diabetes. Currently, the association of renal function with hypoglycemic complications in type 2 diabetes mellitus (T2DM) is inconclusive. This study aims to assess the associations between estimated glomerular filtration rate (eGFR) and cumulative incidence of hypoglycemia, hypoglycemia-related hospitalizations, and incidence of outpatient hypoglycemia among T2DM patients in Thailand using a nationwide patient sample. Methods We conducted a nationwide retrospective cohort study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study assessed adult T2DM patients from 831 public hospitals in Thailand in the year 2012–2013. eGFR was categorized into ≥90, 60–89, 30–59, 15–29, and
Individual and societal consequences of hypoglycemia: A cross-sectional survey
Published in Postgraduate Medicine, 2015
Mikala Dømgaard, Malene Bagger, Nicolai Alexander Rhee, Christopher Malcolm Burton, Birger Thorsteinsson
Background. Hypoglycemia and fear of hypoglycemia threaten individuals’ ability to work and drive. We studied the effect of hypoglycemia on the individual and society, with a focus on possible implications of new European union legislation on patients’ continued ability to drive. Methods. A cross-sectional survey of Danish Diabetes Association members was conducted to investigate individual and societal consequences of hypoglycemia. Results. A total of 3117/9951 individuals with type 1 diabetes (T1DM) (32.2%) or type 2 diabetes (T2DM) (67.8%) completed the survey. The calculated incidence rates of self-reported severe and mild hypoglycemia were 2.9, 0.6 and 0.1 events per patient year (ppy) in patients with T1DM, insulin using T2DM and non-insulin using T2DM, respectively; and incidence rates of self-reported mild hypoglycemia were 99.0, 23.2 and 10.9 events ppy, respectively. Self-care strategies to avoid hypoglycemia include maintaining higher blood glucose levels (45.7%) and reducing physical activity (15.7%). Few people take sick leave as a result of hypoglycemia, but prolonged mental recovery ≥4 h following an episode of mild or severe hypoglycemia was reported by 8.7 and 31.0%, respectively. 26.5% of patients holding a valid driving license reported having ever had at least one episode of severe hypoglycemia. Patients considering underreporting of hypoglycemia to maintain their driving license were more likely to have experienced severe hypoglycemia (odds ratio [OR]: 3.03; 95% CI: 2.42–3.79; p < 0.0001). Conclusion. A high proportion of insulin-treated patients experience hypoglycemia resulting in fear of hypoglycemia and changes in self-care behavior that may compromise glycemic control. Many patients with a history of severe hypoglycemia consider underreporting hypoglycemic events through concern over retaining their driving license.
Approach to Managing Hypoglycemia in Elderly Patients with Diabetes
Published in Postgraduate Medicine, 2010
Kannayiram Alagiakrishnan, Laurie Mereu
Hypoglycemia is a common clinical problem in elderly patients with diabetes. Aging modifies the counterregulatory and symptomatic responses to hypoglycemia. Hypoglycemia in the elderly is not only due to tight blood sugar control, but also due to a multitude of other factors. Hypoglycemia often occurs with insulin, sulfonylureas, or meglitinide therapy. However, other causes may also contribute to hypoglycemia, such as decreased cognition, renal impairment, or polypharmacy. The presenting features of hypoglycemia may be atypical and misinterpreted, resulting in delayed treatment. Morbidity is greater in elderly patients, and the risk of progression to severe hypoglycemia is high because of their altered symptom profile, diminished symptom intensity, and altered glycemic thresholds. Hypoglycemia seems to be the main limiting factor in their glycemic control. In this article we discuss strategies to prevent hypoglycemic episodes.
Related Knowledge Centers
- Glucose
- Hyperglycemia
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