Hypoglycemia, Research Paper Example

Hypoglycemia is a term that refers to a patient who exhibits a low blood glucose concentration.  A low blood glucose results in low energy.  Hypoglycemia is usually uncommon in both adults and children over 10 years of age, unless the patient is undergoing diabetes treatment, as well as other factors, such as different types of medications, hormone or enzyme problems, tumors, or different types of diseases.  (NIH, 2003)  Hypoglycemia is an extremely dangerous disease because it can lead to or cause brain damage if it becomes a chronic condition.  Hypoglycemia usually occurs when there is an excess amount of insulin released with an insufficient amount of glucose intake.  This is usually observed in individuals with diabetes who intake too much insulin and do not consume enough glucose in their diet.  Glucose levels are therefore the most important factor in controlling hypoglycemia from occurring.  (NIH, 2003)

Glucose levels are important because it essentially serves as the “fuel” that energizes the body.  In addition, glucose serves as a metabolic fuel for the brain.  The brain is unable to synthesize glucose on its own; it requires a continuous supply of glucose from the blood circulation.  Furthermore, it is through the glucose counter-regulatory mechanisms in the blood to brain transport system that prevents and correct hypoglycemic conditions in the body. (Endocrine Society, 2009) There are many different types of food that contain sufficient levels of glucose that are needed in the blood transport, such as carbohydrates.  Carbohydrates can be found in food such as pastas, potatoes, bread, and fruit. When an individual consumes food containing carbohydrates, the glucose sugar molecules absorb into the cells via the blood.  The glucose molecules contained in the cells are then used as energy.  The hormone, Insulin, which is produced in the pancreas, facilitates the movement of glucose molecules into the cells.   (NIH, 2003)  If an individual consumes an increased amount of glucose, it is stored in the form of glycogen in the body’s liver and muscles.  In addition, excess glucose can also be stored as fat in fat cells.  As blood glucose levels decrease, glycogen molecules are broken down into glucose molecules and the blood glucose levels begin to level off; however, in diabetic patients, this response doesn’t function properly and the glucose levels do not level off.  (NIH, 2003)

Hypoglycemia, in medical terms, occurs when the blood glucose levels are measured less than 2.8 mmol/L or when the typical signs and symptoms are present without another cause.  The typical symptoms of hypoglycemia are hunger, perspiration, dizziness, nervousness, shakes, weakness, nightmares, irritability, tiredness, tremors, anxiety, headaches, loss of consciousness, and cloudy vision.  (NIH, 2003; Towson University)  As mentioned previously, there are many different factors that can cause hypoglycemia.  Diabetes medications are one major factor.  The reason that these medications cause hypoglycemia is that it increases the insulin production.  There is a long list of medications, such as chlorpropamide (Diabinese), glimepiride (Amaryl), glyburide (DiaBeta, Glynase, Micronase), tolazamide, and many more.  There are also numerous pills when combined together that cause hypoglycemia, such as glipizide + metformin (Metaglip), glyburide + metformin (Glucovance), and many more.  In addition to diabetic medication, individuals who are diabetic and do not eat properly, exercise too excessively, and consume too much alcohol can also be at risk for hypoglycemia.  Furthermore, individuals have a physiological response to decreasing plasma glucose concentration, such as decreased insulin secretion, increases in glucagon secretion, increase in epinephrine secretion, as well as behavioral responses to carbohydrate intake through the perception of symptoms, neurologically.  People with the inability to have normal responses to hypoglycemic conditions usually result in the hypoglycemia disease.  (Endocrine Society, 2009)

In a study conducted by Zoungas (et al. 2010), hypoglycemic patients were divided into different groups based on their ability to treat themselves or the requirement of help in treatment.  For instance, patients that could not treat themselves were termed as having severe hypoglycemia and patients that could treat themselves were termed as having minor hypoglycemia.  During this study, it was found that patients exhibiting severe hypoglycemia had an increased risk for cardiovascular events, cancer, respiratory diseases, digestive problems, skin problems, as well as death.  In addition, it was found that the risks of cardiovascular problems and death were decreased in the patients who were termed with “minor hypoglycemia”.  Therefore, it is important that individuals with the possibility of acquiring hypoglycemia, such as diabetic patients, or patients exhibiting the signs and symptoms of hypoglycemia and monitored and treated.

Individuals with diabetes are at risk for acquiring for hypoglycemia.  Individuals with type 1 diabetes mellitus and advanced type 2 diabetes mellitus show high morbidity rates due to hypoglycemia.  The hypoglycemia is usually treatment-induced from treating for the actual diabetes disease.  In fact, individuals with either type of diabetes have to undergo treatment for hypoglycemia throughout their lifetime however, there have been many advances in hypoglycemia management and treatment for patients with diabetes and has proved to control and decrease the risk of patients obtaining hypoglycemia.  To note, however, there has been no cure for diabetes, as well as the issue of hypoglycemia in diabetic patients.  The only alternative is the treatment plan in these individuals.  (Endocrine Society, 2009)

There are treatment plans that are geared specifically towards preventing and treating hypoglycemia in diabetic patients.  There are several components that should be considered in the treatment plan, such as educating the patient on the options that are available to them, teaching the patient how to self-monitor and treat any type of hypoglycemic episode, and teaching the patient how to identify any complication that can arise from hypoglycemia.  It is suggested that individuals with diabetics self-monitor their blood glucose levels and be aware if their blood glucose concentration falls too low and is not greater than 70 mg/dl.  (Endocrine Society, 2009)  If an individual with diabetes does in fact have hypoglycemia, the treatment plan should follow a specific list to include, medication treatments, continuous self-monitoring, diet and exercise regime, annual eye exams, daily examination of feet, daily examination of skin (especially at the insulin injection site), regular dental examinations and annual influenza vaccinations.  (NIH, 2003)

Diabetes management has also resulted in an increase in the number of cases of adolescents with hypoglycemia; however, hypoglycemic therapy has decreased the number of hypoglycemic events per year in adolescent patients.  Childhood hypoglycemia has different indications than adult cases because there are specific predictors to these patients obtaining severe hypoglycemia, such as age and duration of diabetes.  In addition, there are modifiable predictors such as a lower hemoglobin and high insulin dose.  Therefore, children are more susceptible to acquiring hypoglycemia.  The signs and symptoms for children are usually autonomic and neurologic responses, such as trembling, cold sweating, behavioral changes, mood changes, blurred vision, slurred speech, seizures and possibly death.  The values for the blood glucose levels differ in children as well, with the blood glucose levels below 3.3 mmol/L are the patients put at risk for acquiring hypoglycemia.   Treatment for children depends on the severity of the case and in severe cases glucagon is given immediately through subcutaneous injections.  (Clarke, et al., 2009)

Hypoglycemia is rare in individuals who do not have are not on drug medication for diabetes mellitus.  It is suggested that patients with hypoglycemic symptoms and no diabetes disease should undergo a Whipple’s triad evaluation in order to confirm that a hypoglycemic disorder exists.  A Whipple’s tirad is when a patient has three of the hypoglycemic symptoms confirmed, such as signs consistent with hypoglycemia, low plasma concentration, and lack of signs or symptoms after the glucose concentration stabilizes.  (Endocrine Society, 2009)  Individuals without diabetes that are, however, diagnosed with hypoglycemia are therefore recommended to follow a treatment plan.  The treatment plan begins with a review of the patient history and laboratory results in order to evaluate any type of medication usages, diseases, or hormone imbalances or tumors.  In addition, it is recommended that the patient undergo a screening to observe the plasma glucose levels upon injection of glucagon.  The purpose of this procedure is to determine if hypoglycemia is causes by endogenous (in the body) or exogenous (outside of the body) insulin.  Furthermore, patients are recommended to be undergoing a test to intentionally create hypoglycemic conditions in which signs and symptoms are recorded after the patient fasts for 72 hrs or eat a meal.  The plasma glucose is then evaluated and the concentrations are measured in order to determine if the levels are inadequate.  (Endocrine Society, 2009)

Whether and individual has diabetes or not, the signs and symptoms of hypoglycemia can vary depending on the individual.  It is important for individuals that do have diabetes, however, to understand the signs and symptoms and know how to self monitor.  In addition, individuals with diabetes should train their family and friends to understand the signs and symptoms in case they need help or medical attention.  In regard to children, school staff should also be aware of the child’s illness and ways to treat and prevent.  Overall, hypoglycemia can be a high risk disease for cardiovascular problems, neurological problems, even death.  Therefore, it is important for all at risk individuals, particularly, Diabetes Mellitus patients to be fully aware of management, treatment and prevention methods.

References

Clark, W., Jones, T. Rewers, A., Dunger, D. Klingensmith, G.J.  (2009). Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatric Diabetes 2009: 10 (Suppl. 12): 134–145.

The following article evaluated the clinical signs and symptoms, as well as the predictors that are present for children with diabetes and at risk for acquiring hypoglycemia.  In addition, the article describes the severe harm that can occur in children who have severe hypoglycemia, as well as the treatment plans that should be implemented.

Endocrine Society.  (2009). Evaluation and Management of Adult Hypoglycemic Disorders: An Endocrine Society Clinical Practice Guideline Journal of Clinical Endocrinology & Metabolism, March 2009, 94(3): 709-728.

This article describes the evaluation of adults who are experiencing hypoglycemic disorders.  The article is broken down into different categories for adults who have diabetes and adults who do not have diabetes and are experiencing hypoglycemia.  In addition, analysis and treatment plans are described thoroughly for each type of patient.

NIH. (2003). Hypoglycemia. NIH Publication No. 03-3926. Retrieved from: http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/.

This article is an overview of what hypoglycemia is and who is at risk for acquiring hypoglycemia.  In addition, the article reviews the signs and symptoms, as well as the types of testing individuals can undergo who are experiencing the signs and symptoms, as well as at risk patients, such as diabetic patients.  Furthermore, the types of treatment plans and preventative measures are described.

Towson University.  Hyperglycemia and Hypoglycemia.  Townson University St. Joseph Medical Wellness Center.

This article describes hyperglycemia and hypoglycemia, as well as the signs and symptoms.  In addition, the article describes the treatment options and preventative measures that are necessary in patients experiencing either hyperglycemia or hypoglycemia.

Zoungas, S.  (2010).  Severe Hypoglycemia and Risks of Vascular Events and Death.  N. Engl. J Med. 363: 1410-1418.

The article was a study conducted to examine the association between severe hypoglycemia versus mild hypoglycemia, as well as patients with risks of cardiovascular events. In addition, cardiovascular diseases were compared to patients that were diagnosed with both severe and mild hypoglycemia.