Hypoglycemia medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
==='''Asymptomatic''' === | ==='''Asymptomatic:'''<ref name="pmid19018509">{{cite journal| author=Cryer PE| title=Preventing hypoglycaemia: what is the appropriate glucose alert value? | journal=Diabetologia | year= 2009 | volume= 52 | issue= 1 | pages= 35-7 | pmid=19018509 | doi=10.1007/s00125-008-1205-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19018509 }}</ref> === | ||
* Cases with blood glucose of ≤70 mg/dL with regular monitoring. | * Cases with blood glucose of ≤70 mg/dL with regular monitoring. | ||
* Repeating the measurement in short time | * Repeating the measurement in short time. | ||
* Avoiding critical tasks | * Avoiding critical tasks. | ||
* Ingesting carbohydrates | * Ingesting carbohydrates. | ||
* adjusting the regimen to avoid other attacks. | * adjusting the regimen to avoid other attacks. | ||
=== '''Symptomatic''' === | === '''Symptomatic:'''<ref name="pmid23589542">{{cite journal| author=Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L et al.| title=Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. | journal=Diabetes Care | year= 2013 | volume= 36 | issue= 5 | pages= 1384-95 | pmid=23589542 | doi=10.2337/dc12-2480 | pmc=3631867 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23589542 }}</ref> === | ||
* Patients should have source of carbohydrates available all times. | * Patients should have source of carbohydrates available all times. | ||
* 20 grams is usually sufficient to raise the blood glucose. | * 20 grams is usually sufficient to raise the blood glucose. | ||
* In patients taking alpha-glucosidase inhibitor (acarbose), only dextrose should be used to treat hypoglycemia becuase acarbose slowes digestion of carbohydrates. | * In patients taking alpha-glucosidase inhibitor (acarbose), only dextrose should be used to treat hypoglycemia becuase acarbose slowes digestion of carbohydrates. | ||
=== '''Severe''' === | === '''Severe:''' === | ||
* A subcutaneous or intramuscular injection of 0.5 to 1.0 mg of glucagon will correct hypoglycemia within 15 minutes. | * A subcutaneous or intramuscular injection of 0.5 to 1.0 mg of glucagon will correct hypoglycemia within 15 minutes. | ||
* If failed this attempt or in severe cases, 25% or 50% dextrose intravenously (IV) followed by subcutaneous glucose. | * If failed this attempt or in severe cases, 25% or 50% dextrose intravenously (IV) followed by subcutaneous glucose. | ||
* If these measures aren't available: | * If these measures aren't available: | ||
* Squeezing a glucose gel in the space between the teeth and buccal mucosa with patient head tilted on side to prevent aspiration. | * Squeezing a glucose gel in the space between the teeth and buccal mucosa with patient head tilted on side to prevent aspiration. | ||
* If glucose gel isn't available, putting table sugar under the tongue may save patient. | * If glucose gel isn't available, putting table sugar under the tongue may save patient.<ref name="pmid19025610">{{cite journal| author=Graz B, Dicko M, Willcox ML, Lambert B, Falquet J, Forster M et al.| title=Sublingual sugar for hypoglycaemia in children with severe malaria: a pilot clinical study. | journal=Malar J | year= 2008 | volume= 7 | issue= | pages= 242 | pmid=19025610 | doi=10.1186/1475-2875-7-242 | pmc=2605470 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19025610 }}</ref> | ||
* Hypoglycemia due to hormone deficiencies such as [[hypopituitarism]] or [[adrenal insufficiency]] usually ceases when the appropriate hormone is replaced. | * Hypoglycemia due to hormone deficiencies such as [[hypopituitarism]] or [[adrenal insufficiency]] usually ceases when the appropriate hormone is replaced. | ||
* Patients with diabetes history who has loss of consciousness and there is no method to determine nature of coma; hypoglycemi or hyperglycemia,then glucose should be given empirically. This will correct hypoglycemia and will not be particularly dangerous if blood glucose concentration is high. | * Patients with diabetes history who has loss of consciousness and there is no method to determine nature of coma; hypoglycemi or hyperglycemia,then glucose should be given empirically. This will correct hypoglycemia and will not be particularly dangerous if blood glucose concentration is high. | ||
* Intranasal glucagon was effective in treating insulin-induced hypoglycemia in adults with type 1 diabetes in some studies but it is still under investigation.<ref name="pmid26681725">{{cite journal| author=Rickels MR, Ruedy KJ, Foster NC, Piché CA, Dulude H, Sherr JL et al.| title=Intranasal Glucagon for Treatment of Insulin-Induced Hypoglycemia in Adults With Type 1 Diabetes: A Randomized Crossover Noninferiority Study. | journal=Diabetes Care | year= 2016 | volume= 39 | issue= 2 | pages= 264-70 | pmid=26681725 | doi=10.2337/dc15-1498 | pmc=4722945 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26681725 }}</ref> | |||
=== Postprandial hypoglycemia === | === Postprandial hypoglycemia: === | ||
* Frequent (every three hours) small meals or snacks. | * Frequent (every three hours) small meals or snacks. | ||
* Foods high in fiber, avoiding foods high in sugar. | * Foods high in fiber, avoiding foods high in sugar. | ||
* Regular exercise regimen have been recommended | * Regular exercise regimen have been recommended. | ||
=== Insulinoma === | === Insulinoma: === | ||
Surgery is the best treatment for insulinoma and other pancreatic masses but if multiple metastases or bad general condition medical therapy is accepted: | Surgery is the best treatment for insulinoma and other pancreatic masses but if multiple metastases or bad general condition medical therapy is accepted: | ||
* Diazoxide prevents insulin secretion | * Diazoxide prevents insulin secretion.<ref name="pmid15937909">{{cite journal| author=Hirshberg B, Cochran C, Skarulis MC, Libutti SK, Alexander HR, Wood BJ et al.| title=Malignant insulinoma: spectrum of unusual clinical features. | journal=Cancer | year= 2005 | volume= 104 | issue= 2 | pages= 264-72 | pmid=15937909 | doi=10.1002/cncr.21179 | pmc=4136659 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15937909 }}</ref> | ||
* Octreotide an analog of somatostatin inhibits the secretion of insulin and glucagon. | * Octreotide an analog of somatostatin inhibits the secretion of insulin and glucagon.<ref name="pmid11334727">{{cite journal| author=Aparicio T, Ducreux M, Baudin E, Sabourin JC, De Baere T, Mitry E et al.| title=Antitumour activity of somatostatin analogues in progressive metastatic neuroendocrine tumours. | journal=Eur J Cancer | year= 2001 | volume= 37 | issue= 8 | pages= 1014-9 | pmid=11334727 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11334727 }}</ref> In patients with failed diazoxide attempts. | ||
* Everolimus, an inhibitor of the mammalian is option for refractory cases. | * Everolimus, an inhibitor of the mammalian is option for refractory cases. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Asymptomatic:[1]
- Cases with blood glucose of ≤70 mg/dL with regular monitoring.
- Repeating the measurement in short time.
- Avoiding critical tasks.
- Ingesting carbohydrates.
- adjusting the regimen to avoid other attacks.
Symptomatic:[2]
- Patients should have source of carbohydrates available all times.
- 20 grams is usually sufficient to raise the blood glucose.
- In patients taking alpha-glucosidase inhibitor (acarbose), only dextrose should be used to treat hypoglycemia becuase acarbose slowes digestion of carbohydrates.
Severe:
- A subcutaneous or intramuscular injection of 0.5 to 1.0 mg of glucagon will correct hypoglycemia within 15 minutes.
- If failed this attempt or in severe cases, 25% or 50% dextrose intravenously (IV) followed by subcutaneous glucose.
- If these measures aren't available:
- Squeezing a glucose gel in the space between the teeth and buccal mucosa with patient head tilted on side to prevent aspiration.
- If glucose gel isn't available, putting table sugar under the tongue may save patient.[3]
- Hypoglycemia due to hormone deficiencies such as hypopituitarism or adrenal insufficiency usually ceases when the appropriate hormone is replaced.
- Patients with diabetes history who has loss of consciousness and there is no method to determine nature of coma; hypoglycemi or hyperglycemia,then glucose should be given empirically. This will correct hypoglycemia and will not be particularly dangerous if blood glucose concentration is high.
- Intranasal glucagon was effective in treating insulin-induced hypoglycemia in adults with type 1 diabetes in some studies but it is still under investigation.[4]
Postprandial hypoglycemia:
- Frequent (every three hours) small meals or snacks.
- Foods high in fiber, avoiding foods high in sugar.
- Regular exercise regimen have been recommended.
Insulinoma:
Surgery is the best treatment for insulinoma and other pancreatic masses but if multiple metastases or bad general condition medical therapy is accepted:
- Diazoxide prevents insulin secretion.[5]
- Octreotide an analog of somatostatin inhibits the secretion of insulin and glucagon.[6] In patients with failed diazoxide attempts.
- Everolimus, an inhibitor of the mammalian is option for refractory cases.
References
- ↑ Cryer PE (2009). "Preventing hypoglycaemia: what is the appropriate glucose alert value?". Diabetologia. 52 (1): 35–7. doi:10.1007/s00125-008-1205-7. PMID 19018509.
- ↑ Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L; et al. (2013). "Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society". Diabetes Care. 36 (5): 1384–95. doi:10.2337/dc12-2480. PMC 3631867. PMID 23589542.
- ↑ Graz B, Dicko M, Willcox ML, Lambert B, Falquet J, Forster M; et al. (2008). "Sublingual sugar for hypoglycaemia in children with severe malaria: a pilot clinical study". Malar J. 7: 242. doi:10.1186/1475-2875-7-242. PMC 2605470. PMID 19025610.
- ↑ Rickels MR, Ruedy KJ, Foster NC, Piché CA, Dulude H, Sherr JL; et al. (2016). "Intranasal Glucagon for Treatment of Insulin-Induced Hypoglycemia in Adults With Type 1 Diabetes: A Randomized Crossover Noninferiority Study". Diabetes Care. 39 (2): 264–70. doi:10.2337/dc15-1498. PMC 4722945. PMID 26681725.
- ↑ Hirshberg B, Cochran C, Skarulis MC, Libutti SK, Alexander HR, Wood BJ; et al. (2005). "Malignant insulinoma: spectrum of unusual clinical features". Cancer. 104 (2): 264–72. doi:10.1002/cncr.21179. PMC 4136659. PMID 15937909.
- ↑ Aparicio T, Ducreux M, Baudin E, Sabourin JC, De Baere T, Mitry E; et al. (2001). "Antitumour activity of somatostatin analogues in progressive metastatic neuroendocrine tumours". Eur J Cancer. 37 (8): 1014–9. PMID 11334727.