| Disease |
HYPOGLYCEMIA |
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| Quotation |
“it is just so tempting to rattle off a test or connect the patient to a machine that goes ping. We feel safer with out own clinical judgment if we can “put a number on it” |
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| Definition |
A state of abnormally low plasma glucose levels, with characteristic symptoms (listed below), and relieved by correction of blood sugar level (Whipple’s triad). Often occurring in diabetics on therapy and infrequently in nondiabetics |
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| Prognosis |
Full recovery is usual depending on the rapidity with which the diagnosis is made and therapy offered. There could be permanent intellectual deterioration in patients with repeated episodes. |
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| General Measures |
Most important measure in prevention In hypoglycemia after meals, to give high protein diet with low carbohydrate, and introduce snacks between meals. Post gastrectomy and intestinal resection patients may get “Alimentary hypoglycemia’, 1-2 hours after eating. Acarbose is a useful drug to try. Many get relief from Probantheline which delays gastric emptying. “Hypoglycemia unawareness” can occur in patients on very tight control who presents with lethargy, stupor seizures or coma. They need loosening of the control and repeated glucose estimations. Beta-blockers might contribute to this problem, but on this account are not contra-indicated in diabetics who have need for them. ‘Functional hypoglycemia’ might be helped by dietary therapy in event of IGT. If not repeat small feeds might be tried. |
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| Advice to Patient |
For the diabetic, education on proper dieting, drugs administration, diet modifications, and exercise schedules. Unusual exercise is frequently the cause. Education on proper interpretation of blood glucose values. Educate on early diagnosis of hypoglycemia, and administration of glucagons where needed (patient not enough to take oral glucose) Teach Home glucose monitoring. |
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| Follow Up |
For checking on home glucose monitoring. |
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| Inadequate Response |
Usually occurs in patients on oral hypoglycemics especially long-acting sulphonylureas, and they could be hypoglycemic for hours to days, and would need management in a hospital Also patients in renal failure or hepatic failure erroneously on long acting insulins, or oral hypoglycemics might take to recover and would need hospitalization. |
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| Prevention |
The crux of treatment, as detailed under patient teaching |
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| Reference From |
Home.earthlink.net/-dougwheel/hypo/hypopages.html |
