Be aware of hypoglycemia in diabeticpatients taking insulin
Be aware of hypoglycemia in diabeticpatients taking insulin: Excerpt from Avoiding Common Pediatric Errors
Author:
Sophia Smith, MD
What to Do - Gather Appropriate Data
Type 1 diabetes mellitus is a condition resulting from destruction of the beta
cells in the islets of Langerhans of the pancreas. This results in medically
significant symptoms of hyperglycemia, dehydration, and acidosis, producing derangements in intermediary metabolism. This can lead to diabetic
ketoacidosis, diabetic coma, or even death from absolute or relative insulin
deficiency. Exogenous insulin replacement is the only therapy for this.
Hypoglycemia occurs when the body's blood glucose level drops too
low to provide enough energy for the body's activities. This is a common
side effect of patient's with Type 1 diabetes and relates to excess insulin
administration. Hyperinsulinemic hypoglycemia describes the effects of low
blood glucose caused by excessive insulin. It is the most common type of
severe but transient hyperinsulinemic hypoglycemia occuring accidentally
in persons who take insulin.
Althoughhypoglycemiacanoccursuddenly,itcanalsousuallybetreated
quickly, bringing the blood glucose level back to normal. If the hypoglycemia
is mild, it is easily treated by eating or drinking foods containing carbohydrate. If left untreated, the hypoglycemia can become severe and lead to a
loss of consciousness. In these extreme circumstances, food cannot be eaten,
but glucagon can be injected to quickly raise the blood glucose level.
There are uncommon cases of more persistent harm, and rarely even
death due to severe hypoglycemia. One reason hypoglycemia caused by excessive insulin can be dangerous is that insulin reduces the glucose available
for the brain's energy requirement and brain damage can occur. The conditions range from focal effects to impaired memory and thinking. Children
with prolonged or recurrent hyperinsulinemic hypoglycemia in infancy can
experience harm to their brains and developmental delay. Therefore, the
immediate recognition and intervention of hypoglycemia are important for
a successful outcome.
Hypoglycemia can also occur while asleep. If there are noted periods
of crying out or nightmares; damp pajamas or sheets from perspiration;
or complaints of feeling tired, irritable, or confused upon waking, there
should be a high suspicion for hypoglycemia. The Somogyi phenomenon is a
paradoxical situation of insulin-induced, posthypoglycemic hyperglycemia.
It occurs often in children and adolescents. It is the result of the body's
defense mechanisms against hypoglycemia. It is a hypoglycemia-induced
hyperglycemia, such that if too much insulin is received, the body will try to
protect itself and respond by releasing glucagon from the liver and secreting
diabetogenic hormones, which induce hyperglycemia.
Nocturnal hypoglycemia is dealt with by a readjustment in the timing and dose of insulin. The failure of the Somogyi phenomenon to occur
puts insulin-dependent diabetic patients at increased risk to potential lethal
consequences of nocturnal hypoglycemia.
Suggested Reading
Saleh M, Grunberger G. Hypoglycemia: An excuse for poor glycemic control? Clinical Diabetes
2001;19:161–167.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
More About Diabetic hypoglycemia
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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» Next page: Hyperinsulinism/Hypoglycemia (The 5-Minute Pediatric Consult)
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