Endocrinology – Diabetes Mellitus: By Dawn Dewitt M.D.

Endocrinology – Diabetes Mellitus: By Dawn Dewitt M.D.


Hypoglycemia, or low blood sugars, is the
most common, and one of the most feared, complication of diabetes treatment. It must be taken seriously as patients can
die from this condition. Having an episode raises the risk of mortality
over the next 12 months by 65%. Hypoglycemia is often triggered when those
with uncontrolled diabetes try to achieve “tight control”. You must think of hypoglycemia in a diabetic
patient who presents with signs and symptoms of epinephrine release, like shakiness, anxiety,
tremor, palpitations and sweating. Usually patients with neuroglycopenia, or
low brain blood sugar, have confusion, seizures and coma. Severe hypoglycemia is defined as needing
the help of another person. If a patient with diabetes presents with signs
suggestive of hypoglycemia… remember the following: Consider hypoglycemia even with “normal”
sugar levels in a patient with uncontrolled diabetes. Their glucose may be falling rapidly with
better control You need to rule out mimicking conditions
like acute myocardial ischemia or infection If patients need beta blockers for heart problems,
counsel them that beta-blockers do not usually eliminate the symptoms of hypoglycemia; most
patients on beta-blockers still have profuse “sweats” as a symptom of hypoglycemia Causes of hypoglycemia include: too much insulin or sulfonylurea
mismatch of insulin, sulfonylurea or exercise with food intake
continuing to take diabetes medications with nausea, vomiting or diarrhea
decreased renal clearance of insulin or sulfonylureas Most patients with mild or moderate hypoglycemia
can self-treat with oral glucose like jelly-beans, but hospitalization may be required for severe
hypoglycemia. Remember to continue “basal” insulin in
patients with T1DM! They require insulin and will go into DKA
because they REQUIRE some insulin at all times. Give intravenous glucose as needed. The key to lowering the risk of further episodes
of hypoglycemia includes a detailed understanding the timing of the patient’s medications
insulin (onset, peak and duration) with respect to when they eat and exercise. Frequent blood sugar monitoring is critical.

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