Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Medicine Hypoglycemia PowerPoint PPT presentation
HYPOGLYCEMIA
Reduction of plasma glucose to a level that
induces symptoms and signs
Altered mental status
Sympathetic nervous stimulation
Usual y < 50 mg/dl
Highly variable
Abnormalities of mechanisms of glucose
homeostasis
Whipples triad
Documentation of low blood sugar
Presence of symptoms
Reversal of symptoms with restoration of
blood sugar values
Pathophysiology
Symptoms
Sympathetic activation and brain dysfunction
secondary to decreased blood glucose
Sympathoadrenal
Sweating /palpitations/anxiety/hunger
Neuroglycopenia
Confusion/difficulty in concentration/
irritability/focal impairments/ hal ucinations/coma/
death
Pathophysiology
Adrenergic symptoms precede neuro
glycopenia
Primary stimulus for release of
catacholamines is absolute level of glucose
Previous blood sugar levels can influence
Hypoglycemia unawareness
Repeated episodes can blunt symptoms
Etiology
Medication change / overdose
Infection
Diet change
Metabolic changes
Fasting
Insulin producing tumors
Hepatic disease
Fasting hypoglycemia
Causes
Inherited ? enzyme deficiencies that restrict
hepatic glucose release
Inherited defects in fatty acid oxidation-
restrict the extent to which non neural tissues
can derive their energy from FFA
Nesidioblastosis- budding of insulin secreting
cel s from the pancreatic duct
Drugs ? ethanol/ OHA/ insulin/ INH/
fluoxetine/ SSRI/ ACE inhibitors/ lithium/
tramadol
Sulphonyl urea overuse/ abuse
Exogenous insulin
Endogenous insulin- insulinomas/ non beta
cel tumors
Reactive hypoglycemia
Idiopathic
Alimentary ? GI procedures- rapid entry and
absorption of glucose into the intestine-
excessive insulin response to a meal
Congenital enzyme deficiencies - fructose
intolerance/ galactosemia
Other causes
Auto immune ? insulin and insulin receptor
antibodies
Hormonal deficiencies- hypoadrenalism
hypopitutarism
Critical il ness- hepatic/ renal/ cardiac/ MODS
Exercise
Pregnancy
Renal glycosuria
Ketosis
starvation
Clinical presentation
History
Neuro glycopenic
Adrenergic
Fasting- usual y in the morning before food
Reactive- more common in obese patients/
insulin resistance/ rarely loss of
consciousness, no severe neuro glycopenia
Clinical presentation
Blurred vision/ pupils constricted or dilated or
not reacting
Hypotension/ hypotension/arrhythmias
Coma/ confusion/ fatigue/ diplopia/ agitation/
strokes/ tumors/ convulsions
Dyspnoea/ tachypnoea/ acute pulmonary
edema
Dehydration
Atypical in elderly and the very young
Differentials
Hepatic failure
TIA
Cardiac dysrhythmias
Endocrine disorders
Substance abuse- ethanol/ cocaine
Hypoglycemic agents
CNS disorders
Psychogenic
Work up
Look for
Infection
DKA
Cardiac and neurologic causes
Glucose and insulin levels
Simultaneously
72 hour fasting
C peptide levels increased with insulinoma and
sulphonyl ureas/ low or normal with exogenous
insulin
Imaging
Usg
CT
MRI
Treatment
GLUCOSE / GLUCOSE/ GLUCOSE
Underlying causes
Complications
Acute sequelae
Coma/ cardiac arrest/ death
Permanent deficits increase with
Prolonged hypoglycemia- hemi paresis/
memory impairment/ apraxia/ ataxia/
diminished language skil s
Medication
Dextrose
Glucose elevating agents
Glucagon- inhibits glycogen synthesis/
enhances non carbohydrate glucose
formation
Insulin secretion inhibitors ? diazoxide- direct
inhibitor/ octreotide- somatostatin receptor
Anti neoplastic agents- streptozocin ? tumor
inhibitor
Hypoglycemia Patient
Questionnaire
How wel can you recognize symptoms
How often do you have symptoms
Have you needed assistance
Do you check your glucose before driving
Do your relatives know what to do
THANK YOU
This post was last modified on 12 August 2021