Description
Hypoglycemia is commonly defined as a plasma glucose concentration of less than 70 mg/dL; however, signs and symptoms may not appear until plasma glucose concentrations fall below 55 mg/dL. Since 1938, hypoglycemia has been described using the symptoms of Whipple's triad. To perform Whipple's triad, the practitioner must first diagnose hypoglycemic symptoms, then get low blood glucose, and then demonstrate instant symptom alleviation by treating the low blood glucose with glucose. Under normal circumstances, glucose serves as the brain's principal metabolic fuel source. Unlike other human tissues, the brain has a limited amount of glucose. As expected, the brain requires a continuous supply of blood glucose for proper metabolic activity. An interruption in glucose delivery has the potential to cause difficulties.
Résumé
- Hypoglycemia is defined as a clinical syndrome with diverse causes where low plasma glucose concentration leads to symptoms, signs, and resolution after correction. According to the ADA, it's defined as blood sugar levels less than 70 mg/dL. Whipple's triad is a common diagnostic tool, consisting of signs and symptoms consistent with hypoglycemia, associated low glucose recordings, and immediate symptom relief with glucose supplementation.
- The categories of hypoglycemia include Level 1 (glucose levels less than 70 mg/dL but more than 54 mg/dL), Level 2 (less than 54 mg/dL), and Level 3 (severe event characterized by altered mental and physical status requiring assistance for treatment). The brain relies almost exclusively on glucose; when glucose levels drop below 80 mg/dL, physiological and behavioral defenses activate glycogen breakdown and release counter-regulatory hormones like glucagon, epinephrine, growth hormone, and cortisol.
- Common causes of hypoglycemia in diabetic patients include mismatches between medication and meal timing, especially with insulin. Other causes include elderly bedridden patients, acute gastroenteritis, alcohol consumption, insulinoma, renal failure, and menses. Signs and symptoms typically include increased hunger, irritability, lightheadedness, shivering, dizziness, fatigue, blurred vision, and trembling.
- Management includes patient education by diabetic educators or dieticians, explaining hypoglycemia in their language. SMBG (self-monitoring of blood glucose) and CGM (continuous glucose monitoring) can help monitor sugar levels, especially in type 1 diabetes and pregnant patients with gestational diabetes. Individualized goals for blood sugar levels should be set based on the patient's comorbidities, balancing the need for control with avoiding hypoglycemia.
- Treatment of hypoglycemia involves the 15-15 rule: taking 15 grams of carbohydrate, rechecking blood sugar levels after 15 minutes, and repeating if needed. Suitable examples include half a banana, half a cup of orange juice, or glucose tablets. Choosing the correct food for correction is essential. Also, patients with recurrent hypoglycemia and autonomic neuropathy may require glucagon emergency kits at home.
Exemple de certificat
À propos des intervenants
Dr. Pratiksha Patil
Consultant Diabetologist, Pratham Specialty Clinic, Mumbai
Divulgation financière
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