Instructions
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Hypoglycemia, also known as low blood sugar or low blood glucose, is a fall in blood sugar to levels below normal,[1] and is a significant problem for people with diabetes. Glucose is the main source of energy for the body. Usually, blood glucose is very well-regulated by the endocrine system, keeping levels in the normal range of about 90mg/dL, with comparatively small fluctuations occurring due to fasting, high carbohydrate meals, activity level and time of day. The short-term effects of hypoglycemia can lead to long-term physical and mental complications. Surprisingly, it is not uncommon for patients to have no warning that a hypoglycemic episode is starting. This is why it is extremely important for healthcare professionals to have a good understanding of the pathophysiology, assessment, and treatment options for this population—and be able to pass on this key information to their patients. The early recognition of this complication is crucial for its appropriate treatment and prevention, and to reduce adverse outcomes.
Low blood sugar can make routine, everyday tasks difficult, and can put the diabetic patient in danger if they are involved in certain activities when a hypoglycemic episode occurs. Driving a car, walking down stairs, or using power tools can become life-threatening if a hypoglycemic episode strikes. This is why it’s crucial for the diabetic patient to recognize the symptoms of low blood sugar, know what causes them, and know how to prevent hypoglycemia from occurring. And it’s vitally important for patients to know how to treat it quickly and efficiently, once it does occur.
Given the introduction, let's establish our criteria for what we'll discuss today. The learning objectives for this program are listed below. Upon completion of this course you should be able to: 1. List 2 causes of hypoglycemia. 2. Describe the 15-15 Rule. 3. List 3 strategies to prevent hypoglycemic episodes in patients with diabetes.
Now let's make sure you have a thorough understanding of what hypoglycemia is and what causes it.
Hypoglycemia Defined Low blood sugar, or hypoglycemia, is defined as a blood glucose level below 55mg/dL and the start of cognitive alteration. For a person without diabetes this rarely occurs. But for a diabetic, blood sugar levels below this level can occur frequently. Cognitive impairment is observed in patients when blood glucose levels fall to less than 55mg/dL. Hypoglycemia is generally diagnosed having met the following three conditions: autonomic and/or central nervous system symptoms are present, a low blood glucose level is observed, and a relief of symptoms occurs with treatment.
The Causes of Hypoglycemia Hypoglycemia can be a side effect of insulin or other types of medications used to treat diabetes. Aside from insulin, two types of diabetes medications can cause hypoglycemia: sulfonylureas and meglitinides. In type 2 diabetes (people with beta cells that can still produce insulin), sulfonylureas and meglitinides both lower blood glucose levels by stimulating insulin release from the Beta cells of the pancreas, but with some key differences. Meglitinides bind to the sulfonylurea receptor in beta cells (the insulin-producing cells of the pancreas), but at a different part of the receptor than the sulfonylureas do. And the interaction of meglitinides is different than that of sulfonylureas, achieving a much shorter duration of action (and requiring a higher blood glucose level before the drugs produce insulin secretion from the pancreas). So, meglitinides need to be taken more often than sulfonylureas because they work for a shorter amount of time. So, where to use meglitinides? They may be used in people who are allergic to sulfonylureas, and in older adults who are unable to take insulin. Another advantage of meglitinides is their flexibility compared with sulfonylureas, because of their faster onset and shorter duration of action. Sulfonylureas are usually taken 1-2 times per day, and meglitinides are usually taken 15-30 minutes before eating.
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