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What Are The Signs And Symptoms Of Hyperglycemia And Hypoglycemia?

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Practice Essentials

Hypoglycemia is characterized by a reduction in plasma glucose concentration to a level that may induce symptoms or signs such as altered mental status and/or sympathetic nervous system stimulation. This condition typically arises from abnormalities in the mechanisms involved in glucose homeostasis. The most common cause of hypoglycemia in patients with diabetes is injecting a shot of insulin and skipping a meal or overdosing insulin. The image below depicts a diagnostic algorithm for hypoglycemia. Signs and symptoms The glucose level at which an individual becomes symptomatic is highly variable (threshold generally at < 50 mg/dL). Carefully review the patient's medication and drug history for potential causes of hypoglycemia (eg, new medications, insulin usage or ingestion of an oral hypoglycemic agent, possible toxic ingestion). The patient’s medical and/or social history may reveal the following: Diabetes mellitus, renal insufficiency/failure, alcoholism, hepatic cirrhosis/failure, other endocrine diseases, or recent surgery Central nervous system: Headache, confusion, personality changes Ethanol intake and nutritional deficiency Weight reduction, nausea and vomiting Neurogeni Continue reading >>

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  1. CalgaryDiabetic

    Metformin (very) bad if this is true

    http://www.medscape.com/viewarticle/877965

  2. CalgaryDiabetic

    Metformin Use Linked to Increased Dementia, Parkinson's Risk in Patients With Diabetes
    Deborah Brauser
    March 30, 2017
    VIENNA, Austria — Long-term use of the diabetes medication metformin may increase the risk for neurodegenerative disease in patients with type 2 diabetes mellitus (T2DM), new research suggests.
    In a cohort study that followed about 9300 patients with T2DM in Taiwan for up to 12 years, the risk for Parkinson's disease (PD) or Alzheimer's dementia was more than double during a 12-year period for those who took metformin vs those who did not — even after adjusting for multiple confounders.
    In addition, outcome risks increased progressively with higher dosage and longer duration of treatment.
    The results were presented here at AD/PD 2017: The 13th International Conference on Alzheimer's and Parkinson's Diseases by Yi-Chun Kuan, MD, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.


    Dr Yi-Chun Kuan Interestingly,
    recent research has suggested that use of metformin may protect against neurodegenerative diseases. When asked about that, Dr Kuan told Medscape Medical News that "some studies have actually found positive [outcomes] but some have been negative." So the researchers wanted to look into this using their own data.
    "We'd heard about a possible protective effect from metformin. However, we found the reverse," she said, but stressed that large-scale, prospective studies in other countries are needed to clarify the results.
    Higher Cumulative Incidences
    The investigators note that past research has shown a link between T2DM and increased risk for neurodegenerative diseases, but there's been "some question" about the association with specific diabetes medications.
    They examined records for patients with T2DM from the National Health Insurance research database of Taiwan, including 4651 who had metformin prescriptions and 4651 matched controls who were not using the medication.
    After adjustment for factors such as age, sex, and diabetes severity, "the cumulative incidences of Parkinson's and dementia were significantly higher for our metformin cohort" at 12 years (P < .001), reported Dr Kuan.

  3. CalgaryDiabetic

    Table 1. Outcomes in Metformin Users vs Nonusers


    Outcome
    Event Rate (%)
    Adjusted Hazard Ratio (95% Confidence Interval)
    PD
    6.85 vs 2.78
    2.27 (1.66 - 3.07)
    All-cause dementia
    11.5 vs 6.7
    1.66 (1.35 - 2.04)
    Alzheimer's dementia
    1.64 vs 0.83
    2.13 (1.20 - 3.79)
    Vascular dementia
    1.64 vs 0.69
    2.30 (1.25 - 4.22) In addition, the outcomes mostly increased as the use duration and dosage of metformin increased, especially with use for more than 300 days and doses greater than 240 g.
    Table 2. Comparison of Metformin Use Duration vs Nonuse


    Risk
    Event Rate (%)
    Adjusted Hazard Ratio (95% Confidence Interval)
    For PD
    <180 d
    5.90
    1.77 (1.17 - 2.68)
    180 - 300 d
    4.30
    1.46 (0.90 - 2.37)
    300 - 400 d
    6.05
    2.20 (1.47 - 3.28)
    ≥400 d
    14.3
    4.49 (3.06 - 6.58)
    For all-cause dementia
    <180 d
    7.99
    1.02 (0.74 - 1.41)
    180 - 300 d
    11.4
    1.79 (1.32 - 2.43)
    300 - 400 d
    10.4
    1.61 (1.21 - 2.16)
    ≥400 d
    20.6
    2.84 (2.12 - 3.82) Continue Reading

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