Hypoglycemia medical therapy
|
Hypoglycemia Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Hypoglycemia medical therapy On the Web |
|
American Roentgen Ray Society Images of Hypoglycemia medical therapy |
|
Risk calculators and risk factors for Hypoglycemia medical therapy |
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.