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Diabetes Mellitus with Hypoglycemia

Diabetic Hypoglycemia


Presentation

  • The present study is aimed at measuring the determinants and predictors of hypoglycaemia among diabetes patients.[endocrine-abstracts.org]
  • Methods: A retrospective chart review of the UMass Diabetes clinic database was conducted, and included Diabetic adults on insulin who presented to the clinic in September 2013.[shmabstracts.com]
  • These symptoms, however, if present, last only a few minutes.[diabetesincontrol.com]
  • The clinical presentation often closely mimics genuine clinical conditions and patients often show concern about their condition and are keen for investigation and interventions.[clinchem.aaccjnls.org]
  • Other antidiabetes medications such as dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) agonists, and sodium-glucose contransporter-2 (SGLT-2) agents carry a lower but present risk of hypoglycemia, which may increase when combining[unboundmedicine.com]
Fatigue
  • They include frequent urination (polyuria), excessive thirst (polydipsia), fatigue, blurred vision, tingling or loss of feeling in the hands and feet (diabetic neuropathy), sores that do not heal well, and weight loss.[icdlist.com]
  • A fall in blood glucose causes symptoms such as hunger, sweating, shakiness, fatigue, weakness, and inability to think clearly, whereas severe hypoglycemia causes symptoms such as confusion, seizures, and coma.[msdmanuals.com]
  • Mild hypoglycemia—for example, blood glucose concentrations less than 55 mg per 100 ml (3 mmol/l)—causes hunger, fatigue , tremour, rapid pulse , and anxiety .[britannica.com]
  • The main symptoms associated with hypoglycemia are: Sweating Fatigue Feeling dizzy Symptoms of hypoglycemia can also include: Being pale Feeling weak Feeling hungry A higher heart rate than usual Blurred vision Confusion Convulsions Loss of consciousness[diabetes.co.uk]
  • Although most episodes of nocturnal hypoglycemia are asymptomatic, some patients complain of sleep disturbances (vivid dreams or nightmares), morning headache (a “hung-over” sensation), chronic fatigue, or mood changes (mainly depression).[journals.plos.org]
Euthyroid
  • He was biochemically euthyroid. Discussion Hypoglycemia is a common complication of insulin therapy in patients with DM, and is a barrier to the achievement of glycemic control.[clinchem.aaccjnls.org]
High Fever
  • Physical signs and symptoms of HHNS include: Severe hyperglycemia (greater than 600 mg/dL) Dry, parched mouth Extreme thirst (which may gradually disappear) Warm, dry skin that does not sweat High fever (greater than 101 degrees F) Sleepiness or confusion[visionaware.org]
Mitral Valve Prolapse
Hyperpigmentation
  • There was no abnormal hyperpigmentation typical of Addison's disease. The thyroid gland was not enlarged, and he was clinically euthyroid. Cardiovascular and respiratory examinations were unremarkable.[clinchem.aaccjnls.org]
Dermatitis
  • […] complications 2016 2017 2018 2019 Billable/Specific Code Questionable As Admission Dx with hypoglycemia E11.649 ICD-10-CM Codes Adjacent To E11.649 E11.62 Type 2 diabetes mellitus with skin complications E11.620 Type 2 diabetes mellitus with diabetic dermatitis[icd10data.com]
Sexual Dysfunction
  • Other long-term complications of diabetes include skin problems, digestive problems, sexual dysfunction, and problems with your teeth and gums. Very high or very low blood sugar levels can also lead to emergencies in people with diabetes.[icdlist.com]
Headache
  • The percentage of participants who have experienced hypoglycaemia who know the following symptoms (sweatiness, shivering, hunger, weakness, palpitations, anxiety, confusion, visual disruption, light-headedness, convulsion, headache, inability to concentrate[endocrine-abstracts.org]
  • Symptoms of Hypoglycemia Symptoms of hypoglycemia include the following: Sweating Rapid pulse Shakiness, dizziness, weakness Decreased coordination Difficulty concentrating Blurred vision Headache Trouble performing routine tasks Note: Symptoms can vary[visionaware.org]
  • Symptoms include: Shaking, sweating, rapid heartbeat Change in vision Hunger Headache Sudden moodiness As the term implies, low blood sugar, or hypoglycemia, occurs when your brain and body are not getting enough sugar.[dtc.ucsf.edu]
  • Side effects of glucagon can include nausea and headache, but these can also occur after severe hypoglycemia even when glucagon is not used.[en.wikipedia.org]
Neurologic Manifestation
  • In rare cases of sustained neurological manifestations solely attributed to hypoglycemia, some experts recommend the administration of dexamethasone. 40 Prevention of relapse in the short term Restoration of plasma glucose levels after an acute hypoglycemic[diabetesincontrol.com]
  • Presenting features Neurological manifestations include coma, convulsions, transient hemiparesis and stroke, while reduced consciousness and cognitive dysfunction may cause accidents and injuries.[patient.info]
  • PubMed Central View Article Google Scholar Malouf R, Brust JC: Hypoglycemia: causes, neurological manifestations, and outcome.[jdmdonline.biomedcentral.com]

Workup

  • . • Some patients have symptoms but normal blood glucoses; they need no further workup, in spite of their insistence. 20.[slideshare.net]

Treatment

  • Previous studies have examined whether intensive treatment of high blood glucose levels could decrease the risk of these events. Hypoglycemia can occur as a result of intensive treatment of T2D.[medivizor.com]
  • Evidence Intensive DM treatment is associated with a greater risk of hypoglycemia.[elsevier.es]
  • In addition, other factors such as female gender, lower body-mass index, type 1 Diabetes, hypertension, and use of insulin alone as treatment modality, are associated with higher frequency of hypoglycemia.[shmabstracts.com]
  • Severe or frequent hypoglycemia requires modification of treatment regimens, including higher treatment goals.[unboundmedicine.com]

Etiology

  • Undetectable C-peptide concentrations during 3 separate episodes of hypoglycemia excluded endogenous hyperinsulinism, such as caused by insulinoma, as the etiology of recurrent hypoglycemia ( 3 ).[clinchem.aaccjnls.org]
  • Etiology and Pathophysiology Loss of hormonal counterregulatory mechanism in glucose metabolism Too little food (skipping or delaying meals), decreased CHO intake Too much insulin or oral hypoglycemic agent (improper dose, timing, or erratic absorption[unboundmedicine.com]
  • Abstract In patients with hypoglycemia, the etiologic diagnosis depends on an interpretation of the response of the blood sugar to various provocative tests, usually including the administration of glucose, tolbutamide, L-leucine, and a prolonged fast[annals.org]
  • References: [1] Etiology Clinical features Symptoms of hypoglycemia normally present at approx. 50 mg/dL (2.8 mmol/L) ; however, this threshold is variable.[amboss.com]
  • It is very important, however, to keep in mind that hypoglycemia tends to relapse in some cases, this tendency depending on the etiology of the initial decline in plasma glucose (Box 4.1).[diabetesincontrol.com]

Epidemiology

  • ALERT Hypoglycemia unawareness Major risk factor for severe hypoglycemic reactions Most commonly found in patients with long-standing T1DM and children age Epidemiology Incidence From the ACCORD study, the annual incidence of hypoglycemia was the following[unboundmedicine.com]
  • The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ 2010; 340: b4909. 32. Nordin C.[diabetesincontrol.com]
  • Epidemiologic evidences suggest that unless effective preventive measures are implemented the global prevalence will continue to rise [ 2 ].[jdmdonline.biomedcentral.com]
  • The DCCT Research Group, Epidemiology of severe hypoglycemia in the Diabetes Control and Complications Trial. Am J Med. 1991;90450- 459 Google Scholar Crossref 23.[jamanetwork.com]
  • However, it continues to be a neglected complication with very limited epidemiological data in our country.[ijem.in]
Sex distribution
Age distribution

Pathophysiology

  • DEVELOPMENT: After reviewing the pathophysiology of hypoglycemia in diabetic patients we will review the role of hypoglycemia in three clinical situations: the hypoglycemia-associated autonomic failure, the brain effects of hypoglycemia in children and[ncbi.nlm.nih.gov]
  • Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities. Diabetes Care 2005;28:2948-61. Kjekshus J, Gilpin E, Cali G et al. Diabetic patients and beta-blockers after acute myocardial infarction.[ebmconsult.com]
  • Etiology and Pathophysiology Loss of hormonal counterregulatory mechanism in glucose metabolism Too little food (skipping or delaying meals), decreased CHO intake Too much insulin or oral hypoglycemic agent (improper dose, timing, or erratic absorption[unboundmedicine.com]
  • Google Scholar Zammitt NN, Frier BM: Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities.[jdmdonline.biomedcentral.com]
  • Hypoglycemia: pathophysiology, diagnosis, and treatment . Oxford University Press. ISBN 978-0-19-511325-9 . Laing SP, Swerdlow AJ, Slater SD, et al. (June 1999).[en.wikipedia.org]

Prevention

  • The prevention of hypoglycemia requires some principles consideration.[jdmdonline.biomedcentral.com]
  • Harrison Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes [63] A.A. Howard, J.H. Arnsten, M.N.[elsevier.es]
  • Over time, the beta cells become less able to respond to blood sugar changes, leading to an insulin shortage that prevents the body from reducing blood sugar levels effectively.[icdlist.com]
  • Management of hypoglycemia caused by insulin treatment Management includes the following steps: Restoration of normal plasma glucose levels Prevention of relapse in the short term Prevention of recurrent episodes in the long term.[diabetesincontrol.com]
  • General Prevention Maintain routine schedule of diet (consistent CHO intake), medication, and exercise ( 1 )[ A ].[unboundmedicine.com]

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