Description
Hypoglycemia in adults refers to an abnormally low level of blood glucose, typically below 70 mg/dL, and can cause a range of symptoms from mild discomfort to severe medical emergencies. It often results from an imbalance between insulin or oral hypoglycemic agent administration and carbohydrate intake, commonly affecting individuals with diabetes. Symptoms of hypoglycemia can include shakiness, sweating, confusion, irritability, dizziness, and palpitations. If not promptly addressed, it can lead to severe neurological symptoms such as seizures, loss of consciousness, and even coma. Factors contributing to hypoglycemia include excessive doses of insulin or diabetes medications, skipping meals, intense physical activity, and alcohol consumption. Immediate treatment involves the consumption of fast-acting carbohydrates, such as glucose tablets, fruit juice, or regular soda. For recurrent episodes, it is crucial to identify and manage underlying causes, which may involve adjusting medication dosages, meal planning, and continuous glucose monitoring. In severe cases, where an individual is unable to self-treat, emergency glucagon administration and medical intervention may be necessary. Preventive strategies include regular monitoring of blood glucose levels, educating patients on recognizing early symptoms, and ensuring proper coordination between diet, medication, and physical activity.
Résumé
- Glucose is the primary metabolic fuel for the brain, sourced from intestinal absorption (exogenous) and the breakdown of glycogen (glycogenolysis) and the production of glucose from non-carbohydrate sources (gluconeogenesis) within the body. Glycogenolysis occurs mainly in the liver, while gluconeogenesis happens in the liver and kidneys using amino acids and fatty acid derivatives. After utilization, blood glucose undergoes glycolysis, is stored as glycogen, or is converted into fatty acids. The brain alone utilizes 25% of the body's basal glucose.
- The body maintains stable blood glucose levels through a balance of glucose influx and efflux. Insulin is the only hormone that lowers blood glucose levels, while glucagon, epinephrine, and cortisol are counter-regulatory hormones that elevate blood glucose. Glucose influx occurs through intestinal absorption and endogenous production in the liver and kidneys. Glucose efflux involves the utilization of glucose by the brain and other tissues.
- Hypoglycemia occurs when glucose appearance is less than glucose disappearance, potentially leading to clinical hypoglycemia, defined as a blood glucose concentration low enough to cause symptoms, signs, or impairment of brain function. The body responds to hypoglycemia by decreasing insulin secretion, increasing the secretion of counter-regulatory hormones, and activating sympathetic neural and adrenal medullary responses.
- Clinical manifestations of hypoglycemia are categorized into neurogenic (sympathy adrenal discharge) and neuroglycopenic (brain glucose deprivation) symptoms. Neurogenic symptoms include sweating, tingling, and palpitations, whereas neuroglycopenic symptoms include confusion, dizziness, and seizures. Accurate diagnosis requires documenting Whipple's triad: consistent symptoms and signs of hypoglycemia, a low blood glucose level at the time of symptoms, and resolution of symptoms upon glucose correction.
- In seemingly well individuals, the causes of hypoglycemia include drug effects, critical illness, hormonal deficiencies, and nonlet cell tumors. Specific causes also include endogenous hyperinsulinism (insulinoma or beta cell functional disorders), non-insulin pancreatogenous hypoglycemia, and autoimmune hypoglycemia. Evaluation involves thorough history taking, physical examination, and targeted investigations to identify the underlying cause.
- Management of hypoglycemia involves immediate correction with glucose tablets or carbohydrates, glucagon injection if oral intake is not possible, and intravenous dextrose for severe cases. Definitive treatment includes addressing the underlying cause, such as discontinuing offending drugs, treating critical illness, correcting hormonal deficiencies, or surgically resecting tumors. For unresectable conditions, frequent meals and medications such as alpha-glucosidase inhibitors may be used.
- In patients with diabetes, hypoglycemia is a common complication that can be life-threatening. Risk factors include insulin use, missed meals, exercise, alcohol, and renal failure. Strategies for preventing and managing hypoglycemia include patient education, frequent blood glucose monitoring, individualized glycemic goals, and prompt treatment with carbohydrates or glucagon. Recurrent episodes of hypoglycemia can lead to hypoglycemia-associated autonomic failure (HAAF) and impaired awareness of hypoglycemia.
Exemple de certificat
À propos des intervenants
Dr. Adarsh K.S.
Consultant in Dept of Endocrinology, Manipal Hospitals,Bangalore
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