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3) Asymptomatic hypoglycemia
An event not accompanied by typical symptoms of
hypoglycemia but with a measured plasma glucose
concentration ≤70 mg/dl.
Since the glycemic threshold for activation of
glucagon and epinephrine secretion as glucose
levels decline is normally 65–70 mg/dl and since
antecedent plasma glucose concentrations of ≤70
mg/dl reduce sympathoadrenal responses to
subsequent hypoglycemia, this criterion sets the
lower limit for the variation in plasma glucose in
nondiabetic, nonpregnant individuals as the
conservative lower limit for individuals with diabetes.
4) Probable symptomatic
hypoglycemia
An event during which symptoms of hypoglycemia are
not accompanied by a plasma glucose determination
(but that was presumably caused by a plasma glucose
concentration ≤70 mg/dl).
Since many people with diabetes choose to treat
symptoms with oral carbohydrate without a test of
plasma glucose, it is important to recognize these
events as “probable” hypoglycemia. Such self-reported
episodes that are not confirmed by a contemporaneous
low plasma glucose determination may not be suitable
outcome measures for clinical studies that are aimed at
evaluating therapy, but they should be reported.
5) Relative hypoglycemia
An event during which the person with diabetes reports
any of the typical symptoms of hypoglycemia, and
interprets those as indicative of hypoglycemia, but with a
measured plasma glucose concentration ≤70 mg/dl.
This category reflects the fact that patients with
chronically poor glycemic control can experience
symptoms of hypoglycemia at plasma glucose levels ≤70
mg/dl as plasma glucose concentrations decline toward
that level. Though causing distress and interfering with
the patient’s sense of well-being, and potentially limiting
the achievement of optimal glycemic control, such
episodes probably pose no direct harm and therefore may
not be a suitable outcome measure for clinical studies
that are aimed at evaluating therapy, but they should be
reported.
HYPOGLYCEMIA
1) Severe
2) Documented symptomatic
3) Asymptomatic
4) Probable symptomatic
5) Relative
Hypoglycemia
Whipple’s Triad
Neuroglycopenic symptoms
Neurogenic (or autonomic) symptoms are the result of the
perception of physiological changes caused by the activation
of the ANS triggered by hypoglycemia.
Other Tests:
Plasma glucose overnight fasting - <60 mg/dL
Plasma glucose 72-hour fasting
<45 mg/dL (2.5 mmol/L) for females
<55 mg/dL (3.05 mmol/L for males
Oral glucose tolerance - <50 mg/dL
Insulin radioimmunoassay - Insulin levels elevated if islet cell tumor
present
How do we treat
Hypoglycemia?
Emergency Department Care
The initial approach should include the following: ABCs,
intravenous (IV) access, oxygen, monitoring, and
Accucheck. Administration of glucose as part of the initial
evaluation of altered mental status often corrects
hypoglycemia.
Treatment should not be withheld while waiting for a
laboratory glucose value. Because the brain uses glucose
as its primary energy source, neuronal damage may occur
if treatment of hypoglycemia is delayed.
A hyperglycemic patient with an altered mental status may receive
a bolus of glucose. This procedure is unlikely to harm the patient
with high glucose; however, the delay in giving glucose to the
hypoglycemic patient may be detrimental.
If an Accucheck can be performed immediately, awaiting the
results of this test (available within 1 minute) before deciding
whether to administer glucose is reasonable.
Emergency Department Care
Once the diagnosis of hypoglycemia is made,
search carefully for the cause in the previously
healthy patient.
Patient Education
Diabetic patients with episodes of hypoglycemia
need education in nutrition, checking glucose
levels at home, and early signs and symptoms of
hypoglycemia.
Recognition of early symptoms is paramount for
self-treatment
Preventing recurrence of
hypoglycemia
Treatment of the precipitating event
which caused the hypoglycemia
Reduction or adjustment of the
implicated medications
Replacement of the respective
hormones necessary
Eating meals at the right time
consistently
Prevention
To help prevent hypoglycemia, you should
keep in mind several things:
Your diabetes medications. Some
medications can cause hypoglycemia. Ask
health care provider if yours can. Also,
always take medications and insulin in the
recommended doses and at the
recommended times.
What to Ask Your Doctor About
Diabetes Medications
Could my diabetes medication cause
hypoglycemia?
When should I take my diabetes
medication?
How much should I take?
Should I keep taking my diabetes
medication if I am sick?
Should I adjust my medication before
exercise?
Normal and target blood glucose ranges
(mg/dL)
Normal blood glucose levels in people
who do not have diabetes.
Upon waking (fasting): 70 to 110
After meals: 70 to 140
The following is the philosophy of Charles Schultz, the creator of the "Peanuts" comic strip. You don't have to actually answer the questions.
The lesson: The people who make a difference in your life are not the
ones with the most credentials, the most money, or the most awards.
They are the ones that care.
Charles Schultz Philosophy
Pass this on to those people who have made a difference in your life. You are receiving this
because you made a difference in mine.
"Don't worry about the world coming to an end today.
It's already tomorrow in Australia." (Charles Schultz)
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