Hypoglycemia natural history, complications and prognosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Hypoglycemia}} | {{Hypoglycemia}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{MAD}} | ||
==Overview== | ==Overview== | ||
If left untreated, patients with hypoglycemia may progress to develop [[anxiety]], [[nervousness]], [[tremor]], [[Palpitation|palpitations,]] and [[sweating]]. Common complications of hypoglycemia include [[psychomotor retardation]], [[epilepsy]] and [[prematurity]] in neonates. Complications in adults include increased risk of [[dementia]], [[cardiovascular]] complications and may be death. [[Prognosis]] is generally good. Four to ten percent of death in patients with [[Diabetes mellitus type 1|type 1 diabetes]] are due to hypoglycemia. | |||
==Natural History== | ==Natural History== | ||
* The symptoms of hypoglycemia are usually developed in the | * The symptoms of hypoglycemia are usually developed in the second decade of life, and start with symptoms such as [[anxiety]], [[nervousness]], [[tremor]], [[Palpitation|palpitations,]] and sweating. | ||
* Without treatment, patient may develop symptoms of [[adrenergic]] manifestations such as [[confusion]], [[amnesia]], [[dizziness]], [[delirium]], [[Diplopia|double vision]], [[slurred speech]], generalized or focal [[Seizure|seizures]] which may eventually lead to death. | |||
* Lower values of [[plasma glucose]] may cause the following manifestations: | |||
**Values ≤55 mg/dL causes [[cognitive impairment]] and [[EEG|EEG (Electroencephalogram)]] changes. | |||
**Values <40 mg/dL causes [[drowsiness]] and change in behavior. | |||
**Values <30 mg/dL can cause [[seizures]], permanent neurological deficits and even death.<ref name="AlsahliGerich2013">{{cite journal|last1=Alsahli|first1=Mazen|last2=Gerich|first2=John E.|title=Hypoglycemia|journal=Endocrinology and Metabolism Clinics of North America|volume=42|issue=4|year=2013|pages=657–676|issn=08898529|doi=10.1016/j.ecl.2013.07.002}}</ref> | |||
==Complications== | ==Complications== | ||
Complications that can develop as a result of neonatal hypoglycemia are: | ==== Complications that can develop as a result of neonatal hypoglycemia are: ==== | ||
* | * [[Psychomotor retardation]] | ||
* [[Epilepsy]]<ref name="pmid12824865">{{cite journal| author=Meissner T, Wendel U, Burgard P, Schaetzle S, Mayatepek E| title=Long-term follow-up of 114 patients with congenital hyperinsulinism. | journal=Eur J Endocrinol | year= 2003 | volume= 149 | issue= 1 | pages= 43-51 | pmid=12824865 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12824865 }}</ref> | |||
* Epilepsy<ref name="pmid12824865">{{cite journal| author=Meissner T, Wendel U, Burgard P, Schaetzle S, Mayatepek E| title=Long-term follow-up of 114 patients with congenital hyperinsulinism. | journal=Eur J Endocrinol | year= 2003 | volume= 149 | issue= 1 | pages= 43-51 | pmid=12824865 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12824865 }}</ref> | * [[Prematurity]] | ||
* | |||
==== Complications that may develop as a result of hypoglycemia in adults are: ==== | |||
Complications that | |||
* It depends on: | * It depends on: | ||
**Duration of the attacks | |||
* Duration of the attacks | **Age of the patients | ||
* Age of the patients | |||
* Older patients show more complications than younger patients.<ref name="pmid16306561">{{cite journal| author=Zammitt NN, Frier BM| title=Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities. | journal=Diabetes Care | year= 2005 | volume= 28 | issue= 12 | pages= 2948-61 | pmid=16306561 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16306561 }}</ref> | * Older patients show more complications than younger patients.<ref name="pmid16306561">{{cite journal| author=Zammitt NN, Frier BM| title=Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities. | journal=Diabetes Care | year= 2005 | volume= 28 | issue= 12 | pages= 2948-61 | pmid=16306561 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16306561 }}</ref> | ||
* Increased risk of dementia<ref name="pmid23753199">{{cite journal| author=Yaffe K, Falvey CM, Hamilton N, Harris TB, Simonsick EM, Strotmeyer ES et al.| title=Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus. | journal=JAMA Intern Med | year= 2013 | volume= 173 | issue= 14 | pages= 1300-6 | pmid=23753199 | doi=10.1001/jamainternmed.2013.6176 | pmc=4041621 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23753199 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24195968 Review in: Evid Based Med. 2014 Apr;19(2):77]</ref> | * Increased risk of [[dementia]]<ref name="pmid23753199">{{cite journal| author=Yaffe K, Falvey CM, Hamilton N, Harris TB, Simonsick EM, Strotmeyer ES et al.| title=Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus. | journal=JAMA Intern Med | year= 2013 | volume= 173 | issue= 14 | pages= 1300-6 | pmid=23753199 | doi=10.1001/jamainternmed.2013.6176 | pmc=4041621 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23753199 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24195968 Review in: Evid Based Med. 2014 Apr;19(2):77]</ref> | ||
* Episodes of dizziness increase the risk of falls and fractures. | * Episodes of [[dizziness]] increase the risk of falls and [[Bone fracture|fractures.]] | ||
* Severe hypoglycemia may increase the risk of cardiovascular complications in type 2 diabetes patients.<ref name="pmid23900314">{{cite journal| author=Goto A, Arah OA, Goto M, Terauchi Y, Noda M| title=Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis. | journal=BMJ | year= 2013 | volume= 347 | issue= | pages= f4533 | pmid=23900314 | doi=10.1136/bmj.f4533 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23900314 }}</ref> | * Severe hypoglycemia may increase the risk of cardiovascular complications in [[Diabetes mellitus type 2|type 2 diabetes]] patients.<ref name="pmid23900314">{{cite journal| author=Goto A, Arah OA, Goto M, Terauchi Y, Noda M| title=Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis. | journal=BMJ | year= 2013 | volume= 347 | issue= | pages= f4533 | pmid=23900314 | doi=10.1136/bmj.f4533 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23900314 }}</ref> | ||
==Prognosis== | ==Prognosis== | ||
* | * Prognosis of hypoglycemia is generally good with treatment. Without treatment, hypoglycemia may be fatal. | ||
* | * Four to ten percents of deaths of patients with [[Diabetes mellitus type 1|type 1 diabetes]] are due to hypoglycemia.<ref name="pmid17901942">{{cite journal| author=Patterson CC, Dahlquist G, Harjutsalo V, Joner G, Feltbower RG, Svensson J et al.| title=Early mortality in EURODIAB population-based cohorts of type 1 diabetes diagnosed in childhood since 1989. | journal=Diabetologia | year= 2007 | volume= 50 | issue= 12 | pages= 2439-42 | pmid=17901942 | doi=10.1007/s00125-007-0824-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17901942 }}</ref> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 19:45, 15 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
If left untreated, patients with hypoglycemia may progress to develop anxiety, nervousness, tremor, palpitations, and sweating. Common complications of hypoglycemia include psychomotor retardation, epilepsy and prematurity in neonates. Complications in adults include increased risk of dementia, cardiovascular complications and may be death. Prognosis is generally good. Four to ten percent of death in patients with type 1 diabetes are due to hypoglycemia.
Natural History
- The symptoms of hypoglycemia are usually developed in the second decade of life, and start with symptoms such as anxiety, nervousness, tremor, palpitations, and sweating.
- Without treatment, patient may develop symptoms of adrenergic manifestations such as confusion, amnesia, dizziness, delirium, double vision, slurred speech, generalized or focal seizures which may eventually lead to death.
- Lower values of plasma glucose may cause the following manifestations:
- Values ≤55 mg/dL causes cognitive impairment and EEG (Electroencephalogram) changes.
- Values <40 mg/dL causes drowsiness and change in behavior.
- Values <30 mg/dL can cause seizures, permanent neurological deficits and even death.[1]
Complications
Complications that can develop as a result of neonatal hypoglycemia are:
Complications that may develop as a result of hypoglycemia in adults are:
- It depends on:
- Duration of the attacks
- Age of the patients
- Older patients show more complications than younger patients.[3]
- Increased risk of dementia[4]
- Episodes of dizziness increase the risk of falls and fractures.
- Severe hypoglycemia may increase the risk of cardiovascular complications in type 2 diabetes patients.[5]
Prognosis
- Prognosis of hypoglycemia is generally good with treatment. Without treatment, hypoglycemia may be fatal.
- Four to ten percents of deaths of patients with type 1 diabetes are due to hypoglycemia.[6]
References
- ↑ Alsahli, Mazen; Gerich, John E. (2013). "Hypoglycemia". Endocrinology and Metabolism Clinics of North America. 42 (4): 657–676. doi:10.1016/j.ecl.2013.07.002. ISSN 0889-8529.
- ↑ Meissner T, Wendel U, Burgard P, Schaetzle S, Mayatepek E (2003). "Long-term follow-up of 114 patients with congenital hyperinsulinism". Eur J Endocrinol. 149 (1): 43–51. PMID 12824865.
- ↑ Zammitt NN, Frier BM (2005). "Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities". Diabetes Care. 28 (12): 2948–61. PMID 16306561.
- ↑ Yaffe K, Falvey CM, Hamilton N, Harris TB, Simonsick EM, Strotmeyer ES; et al. (2013). "Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus". JAMA Intern Med. 173 (14): 1300–6. doi:10.1001/jamainternmed.2013.6176. PMC 4041621. PMID 23753199. Review in: Evid Based Med. 2014 Apr;19(2):77
- ↑ Goto A, Arah OA, Goto M, Terauchi Y, Noda M (2013). "Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis". BMJ. 347: f4533. doi:10.1136/bmj.f4533. PMID 23900314.
- ↑ Patterson CC, Dahlquist G, Harjutsalo V, Joner G, Feltbower RG, Svensson J; et al. (2007). "Early mortality in EURODIAB population-based cohorts of type 1 diabetes diagnosed in childhood since 1989". Diabetologia. 50 (12): 2439–42. doi:10.1007/s00125-007-0824-8. PMID 17901942.