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Diabetic Hypoglycemia
From Wikipedia, the free encyclopedia
Diabetic hypoglycemia describes low blood glucose (hypoglycemia) occurring in a
person with diabetes mellitus. It is one of the most common types of hypoglycemia
seen in emergency departments and hospitals. In general, it occurs when a treatment
to lower the elevated blood glucose of diabetes "overshoots" and causes the glucose
to fall to a below-normal level.
A commonly used "number" to define the lower limit of normal glucose is 70 mg/dl
(3.9 mmol/l), though in someone with diabetes, hypoglycemic symptoms can
sometimes occur at higher glucose levels, or may fail to occur at lower. This
variability is further compounded by the imprecision of glucose meter measurements
at low levels, or the ability of glucose levels to change rapidly.
Diabetic hypoglycemia can be mild, recognized easily by the patient, and reversed
with a small amount of carbohydrates eaten or drunk, or it may be severe enough to
cause unconsciousness requiring intravenous dextrose or an injection of glucagon.
Severe hypoglycemic unconsciousness is one form of diabetic coma. A common
medical definition of severe hypoglycemia is "hypoglycemia severe enough that the
person needs assistance in dealing with it."
Diabetic hypoglycemia can occur in any person with diabetes who takes any medicine
to lower his blood glucose, but severe hypoglycemia occurs most often in people
with type 1 diabetes who take insulin. Hypoglycemia can also be caused by
sulfonylureas in people with type 2 diabetes. Severe hypoglycemia rarely, if ever,
occurs in people with diabetes treated only with diet, exercise, or insulin sensitizers.
Symptoms of diabetic hypoglycemia are those of hypoglycemia: neuroglycopenic,
adrenergic, and abdominal. Symptoms and effects can be mild, moderate or severe,
depending on how low the glucose falls and a variety of other factors. It is rare but
possible for diabetic hypoglycemia to result in brain damage or death.
In North America a mild episode of diabetic hypoglycemia is often termed a "low" or
an "insulin reaction," and in Europe a "hypo". A severe episode is sometimes referred
to as "insulin shock".
Treatment
The blood glucose can be raised to normal within minutes with 15-20 grams of
carbohydrate. It can be taken as food or drink if the person is conscious and able to
swallow. This amount of carbohydrate is contained in about 3-4 ounces (100-120 ml)
of orange, apple, or grape juice, about 4-5 ounces (120-150 ml) of regular (non-diet)
soda), about one slice of bread, about 4 crackers, or about 1 serving of most starchy
foods. Starch is quickly digested to glucose, but adding fat or protein retards
digestion. Symptoms should begin to improve within 5 minutes, though full recovery
may take 10-20 minutes. Overeating does not speed recovery and will simply produce
hyperglycemia afterwards.
If a person is suffering such severe effects of hypoglycemia that they cannot (due to
combativeness) or should not (due to seizures or unconsciousness) be given anything
by mouth, glucose can be given by intravenous infusion or the blood glucose can be
rapidly raised by an injection of glucagon. Glucose is available for intravenous
infusion in various concentrations. The highest is 50% dextrose (about 18 grams of
glucose in 40 ml of fluid), but this should be given carefully as it is damaging to tissue
if the infusion leaks from the vein.
Glucagon is a hormone that rapidly counters the metabolic effects of insulin in the
liver, causing glycogenolysis and release of glucose into the blood. It can raise the
glucose by 30-100 mg/dl within minutes in any form of hypoglycemia caused by
insulin excess (including all types of diabetic hypoglycemia). It comes in tiny vials
containing 1 mg, which is a standard adult dose. The glucagon in the vial is a
lyophilized pellet, which must be reconstituted with 1 ml of sterile water, included in
the "kit". In the widely used Lilly Emergency Kit, the water is contained in a syringe
with a large needle for intramuscular injection and must be injected into the vial with
the pellet of glucagon before being injected. Glucagon works if given subcutaneously,
but absorption and recovery are faster if it is injected deep into a muscle (usually the
middle of the outside of the thigh). It has an even more rapid effect when given
intravenously but this is rarely practicable. Side effects of glucagon can include
nausea and headache, but these can also occur after severe hypoglycemia even when
glucagon is not used. There are no serious risks to glucagon use, and it can usually
produce a faster recovery than calling for paramedics and waiting for them to start an
intravenous line to give dextrose.
To learn more about diabetic hypoglycemia click here
All text is available under the terms of the GNU Free Documentation License (see Copyrights for
details).
From Wikipedia, the free encyclopedia
Diabetic hypoglycemia describes low blood glucose (hypoglycemia) occurring in a
person with diabetes mellitus. It is one of the most common types of hypoglycemia
seen in emergency departments and hospitals. In general, it occurs when a treatment
to lower the elevated blood glucose of diabetes "overshoots" and causes the glucose
to fall to a below-normal level.
A commonly used "number" to define the lower limit of normal glucose is 70 mg/dl
(3.9 mmol/l), though in someone with diabetes, hypoglycemic symptoms can
sometimes occur at higher glucose levels, or may fail to occur at lower. This
variability is further compounded by the imprecision of glucose meter measurements
at low levels, or the ability of glucose levels to change rapidly.
Diabetic hypoglycemia can be mild, recognized easily by the patient, and reversed
with a small amount of carbohydrates eaten or drunk, or it may be severe enough to
cause unconsciousness requiring intravenous dextrose or an injection of glucagon.
Severe hypoglycemic unconsciousness is one form of diabetic coma. A common
medical definition of severe hypoglycemia is "hypoglycemia severe enough that the
person needs assistance in dealing with it."
Diabetic hypoglycemia can occur in any person with diabetes who takes any medicine
to lower his blood glucose, but severe hypoglycemia occurs most often in people
with type 1 diabetes who take insulin. Hypoglycemia can also be caused by
sulfonylureas in people with type 2 diabetes. Severe hypoglycemia rarely, if ever,
occurs in people with diabetes treated only with diet, exercise, or insulin sensitizers.
Symptoms of diabetic hypoglycemia are those of hypoglycemia: neuroglycopenic,
adrenergic, and abdominal. Symptoms and effects can be mild, moderate or severe,
depending on how low the glucose falls and a variety of other factors. It is rare but
possible for diabetic hypoglycemia to result in brain damage or death.
In North America a mild episode of diabetic hypoglycemia is often termed a "low" or
an "insulin reaction," and in Europe a "hypo". A severe episode is sometimes referred
to as "insulin shock".
Treatment
The blood glucose can be raised to normal within minutes with 15-20 grams of
carbohydrate. It can be taken as food or drink if the person is conscious and able to
swallow. This amount of carbohydrate is contained in about 3-4 ounces (100-120 ml)
of orange, apple, or grape juice, about 4-5 ounces (120-150 ml) of regular (non-diet)
soda), about one slice of bread, about 4 crackers, or about 1 serving of most starchy
foods. Starch is quickly digested to glucose, but adding fat or protein retards
digestion. Symptoms should begin to improve within 5 minutes, though full recovery
may take 10-20 minutes. Overeating does not speed recovery and will simply produce
hyperglycemia afterwards.
If a person is suffering such severe effects of hypoglycemia that they cannot (due to
combativeness) or should not (due to seizures or unconsciousness) be given anything
by mouth, glucose can be given by intravenous infusion or the blood glucose can be
rapidly raised by an injection of glucagon. Glucose is available for intravenous
infusion in various concentrations. The highest is 50% dextrose (about 18 grams of
glucose in 40 ml of fluid), but this should be given carefully as it is damaging to tissue
if the infusion leaks from the vein.
Glucagon is a hormone that rapidly counters the metabolic effects of insulin in the
liver, causing glycogenolysis and release of glucose into the blood. It can raise the
glucose by 30-100 mg/dl within minutes in any form of hypoglycemia caused by
insulin excess (including all types of diabetic hypoglycemia). It comes in tiny vials
containing 1 mg, which is a standard adult dose. The glucagon in the vial is a
lyophilized pellet, which must be reconstituted with 1 ml of sterile water, included in
the "kit". In the widely used Lilly Emergency Kit, the water is contained in a syringe
with a large needle for intramuscular injection and must be injected into the vial with
the pellet of glucagon before being injected. Glucagon works if given subcutaneously,
but absorption and recovery are faster if it is injected deep into a muscle (usually the
middle of the outside of the thigh). It has an even more rapid effect when given
intravenously but this is rarely practicable. Side effects of glucagon can include
nausea and headache, but these can also occur after severe hypoglycemia even when
glucagon is not used. There are no serious risks to glucagon use, and it can usually
produce a faster recovery than calling for paramedics and waiting for them to start an
intravenous line to give dextrose.
To learn more about diabetic hypoglycemia click here
All text is available under the terms of the GNU Free Documentation License (see Copyrights for
details).
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