Hypoglycemia natural history, complications and prognosis: Difference between revisions
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==Natural History== | ==Natural History== | ||
* The symptoms of hypoglycemia are usually developed in the first/ second/ third decade of life, and start with symptoms such as [[anxiety]], [[nervousness]], [[tremor]], [[Palpitation|palpitations,]] and sweating. | * The symptoms of hypoglycemia are usually developed in the first/ second/ third decade of life, and start with symptoms such as [[anxiety]], [[nervousness]], [[tremor]], [[Palpitation|palpitations,]] and sweating. | ||
* Without treatment, the patient will 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. | * Without treatment, the patient will 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. | ||
==Complications== | ==Complications== | ||
==== Complications that can develop as a result of neonatal hypoglycemia are: ==== | ==== Complications that can develop as a result of neonatal hypoglycemia are: ==== | ||
* Cognitive problems | * Cognitive problems | ||
* Psychomotor retardation | * [[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> | ||
* Infants with BWS are at increased risk for prematurity and tumors such as hepatoblastoma and Wilm's tumor.<ref name="pmid18000906">{{cite journal| author=Smith AC, Shuman C, Chitayat D, Steele L, Ray PN, Bourgeois J et al.| title=Severe presentation of Beckwith-Wiedemann syndrome associated with high levels of constitutional paternal uniparental disomy for chromosome 11p15. | journal=Am J Med Genet A | year= 2007 | volume= 143A | issue= 24 | pages= 3010-5 | pmid=18000906 | doi=10.1002/ajmg.a.32030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18000906 }}</ref> | * Infants with [[Beckwith-Wiedemann syndrome|BWS]] are at increased risk for [[prematurity]] and tumors such as [[hepatoblastoma]] and [[Wilms' tumor|Wilm's tumor]].<ref name="pmid18000906">{{cite journal| author=Smith AC, Shuman C, Chitayat D, Steele L, Ray PN, Bourgeois J et al.| title=Severe presentation of Beckwith-Wiedemann syndrome associated with high levels of constitutional paternal uniparental disomy for chromosome 11p15. | journal=Am J Med Genet A | year= 2007 | volume= 143A | issue= 24 | pages= 3010-5 | pmid=18000906 | doi=10.1002/ajmg.a.32030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18000906 }}</ref> | ||
* Prematurity | * [[Prematurity]] | ||
==== Complications that can develop as a result of hypoglycemia in adults are: ==== | ==== Complications that can develop as a result of hypoglycemia in adults are: ==== | ||
| Line 22: | Line 22: | ||
**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 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> | ||
* Hypoglycemia can be fatal. | * Hypoglycemia can be fatal. | ||
==Prognosis== | ==Prognosis== | ||
* The prognosis of hypoglycemia is good with treatment. Without treatment, hypoglycemia may be fatal. | * The prognosis of hypoglycemia is 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.<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> | * 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}} | ||
Revision as of 14:42, 25 August 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 the risk of dementia, cardiovascular complications and may be death. Prognosis is generally good, and 4-10% of deaths of patients with type 1 diabetes are due to hypoglycemia.
Natural History
- The symptoms of hypoglycemia are usually developed in the first/ second/ third decade of life, and start with symptoms such as anxiety, nervousness, tremor, palpitations, and sweating.
- Without treatment, the patient will 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.
Complications
Complications that can develop as a result of neonatal hypoglycemia are:
- Cognitive problems
- Psychomotor retardation
- Epilepsy[1]
- Infants with BWS are at increased risk for prematurity and tumors such as hepatoblastoma and Wilm's tumor.[2]
- Prematurity
Complications that can 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]
- Hypoglycemia can be fatal.
Prognosis
- The prognosis of hypoglycemia is 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
- ↑ 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.
- ↑ Smith AC, Shuman C, Chitayat D, Steele L, Ray PN, Bourgeois J; et al. (2007). "Severe presentation of Beckwith-Wiedemann syndrome associated with high levels of constitutional paternal uniparental disomy for chromosome 11p15". Am J Med Genet A. 143A (24): 3010–5. doi:10.1002/ajmg.a.32030. PMID 18000906.
- ↑ 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.