glucose decrease due to lots of reason because there are lots of problem regerding it i detail i have given its problems and causes and symptoms and treatment also

1. Made By: (Group-12)
Mirza Naadirhasan
Modhava Sahel
Chauhan Dhruvi
Private Biochemistry

2.  It is clinical syndrome with diverse causes in which low plasma glucose
concentrations lead to symptoms and signs, and there is resolution of the
symptoms/signs when the plasma glucose concentration is raised .
 In patients with Diabetes, hypoglycemia is defined as : All episodes of an
abnormally low plasma glucose concentration (with or without symptoms) that
expose the individual to harm.
 When the blood glucose concentration falls to less than 45 mg/dl, the symptoms of
hypoglycemia appear.

3.  Headache
 Anxiety
 Confusion
 Sweating
 Slurred speech
 Seizures and coma and if not corrected death.
 All these symptoms are directly and indirectly related to the deprivation of
glucose supply to the central nervous system (particularly the brain) due to a fall
in blood glucose level.

5. 1 . Post-prandial hypoglycemia : This is also called reactive hypoglycemia and is
observed in subjects with an elevated insulin secretion following a meal.
This causes transient hypoglycemia and is associated with mild symptoms.
The patient is advised to eat frequently rather than the 3 usual meals.
2. Fasting hypoglycemia : Low blood glucose concentration in fasting is not very
common.
However, fasting hypoglycemia is observed in patients with pancreatic B-cell tumor
and hepatocellular damage

6.  3. Hypoglycaemia due to alcohol intake : In some individuals who are starved or
engaged in prolonged exercise, alcohol consumption may cause hypoglycaemia.
 This is due to the accumulation of NADH (during the course of alcohol
metabolism by alcohol dehydrogenase) which diverts the pyruvate and
oxaloacetate (substrates of gluconeogenesis) to form, respectively, lactate and
malate.
 ALDL is inhibited by Disulfiram drug
 The net effect is that gluconeogenesis is reduced due to alcohol consumption.
 4. Hypoglycemia due to insulin overdose : The most common complication of
insulin therapy in diabetic patients is hypoglycemia.
 This is particularly observed in patients who are on intensive treatment regime.

7.  5. Hypoglycemia in premature infants : Premature and underweight infants have
smaller stores of liver glycogen, and are susceptible to hypoglycemia.
 6. Hypoglycemia May Occur During Pregnancy :During pregnancy, fetal glucose
consumption increases and there is a risk of maternal and possibly fetal
hypoglycemia, particularly if there are long intervals between meals or at night.
 Furthermore, premature and lowbirth-weight babies are more susceptible to
hypoglycemia, since they have little adipose tissue to generate alternative fuels
such as free fatty acids or ketone bodies during the transition from fetal
dependency to the free-living state.

8.  Drugs are the most common cause of hypoglycemia .
 Hypoglycemia is common in type 1 diabetes, especially in patients receiving
intensive therapy in whom the risk of severe hypoglycemia is increased more than
threefold.
 Less commonly, hypoglycemia may also affect patients with type 2 diabetes who
take either insulin secretagogues or insulin.
 In contrast, hypoglycemia is uncommon in individuals who do not have drug-
treated diabetes mellitus.
 In such patients, hypoglycemia may be caused by a variety of other drugs,
including : alcohol, and common critical illnesses such as hepatic, renal, or cardiac
failure, sepsis, or other drugs.
 It may be due to adrenal insufficiency, an insulinoma, or an IGF-secreting tumor.
In addition, hypoglycemia can be factitious, accidental, or even malicious

10. MILD – autonomic symptoms are present. The individual is able to self Treat.
MODERATE – autonomic & neuroglycopenic symptoms are present and
neuroglycopenic symptoms are also present. The individual is able to self-treat.
 SEVERE – individual requires assistance of another person. Unconsciousness
may of another person. Unconsciousness may occur.

11.  GOALS: To detect and treat a low blood glucose level promptly by using an intervention that
provide a rapid rise in blood glucose to a safe level, eliminating the risk for injury, and relieving
symptoms quickly.
 15 g of glucose will usually increase blood glucose by 2.1 mmol/L within 20 minutes with
adequate symptom relief for most people.
 20 g of glucose will usually increase blood glucose by 3.6 mmol/L within 45 minutes.
 Example of 15g of carbohydrate:
 4 glucose tablets
 15 mL (3 teaspoons) or 3 packets of table sugar dissolved in water
 175 mL (3/4 cup) of juice or regular drink 15 mL (1 teaspoon) of honey
 To prevent repeated hypoglycemia, once the hypoglycemia has been reversed, the person should
have the usual meal or snack that is due at that time of the day.
 If a meal is >1 hour away, a snack (including 15 g Carbohydrate & a protein source) should be
consumed.

12.  MILD TO MODERATE HYPOGLYCEMIA
15 g of oral carbohydrates, preferably as glucose or sucrose tablets or solution.
Retest blood glucose in 15 minutes; repeat treatment if BG still <4.0 mmol/L.
 SEVERE HYPOGLYCEMIA (CONSCIOUS)
20 g of oral carbohydrates (glucose tablets or equivalent); retest in 15 minutes &
repeat treatment if BG still <4.O mmol/L
 SEVERE HYPOGLYCEMIA (UNCONSCIOUS)
1 mg of GLUCAGON subcutaneously or intramascularly or 10 to 25 g of glucose
intraveneously (20 - 50 cc of D50W) dextrose 50% in water

13.  Exogenous insulin and insulin secretagogue (eg, Glyburide , Glipizide ,
Glimepiride , Repaglinide , Nateglinide ) stimulated endogenous insulin secretion
suppress hepatic (and renal) glucose production and stimulate glucose utilization
and, thus, can cause hypoglycemia, particularly in the setting of compromised
defenses.
 Even in the setting of intact defenses, these drugs can cause hypoglycemia when
given in sufficient doses.
 Among the commonly used sulfonylureas, Glimepiride and Glyburide
(Glibenclamide) are more often associated with hypoglycemia than glipizide
because of the longer duration of actions..

14.  Among the drugs used to treat type 2 diabetes early in its course, insulin
sensitizers ( metformin , Glitazones), glucosidase inhibitors, glucagon-like peptide-
1 (GLP-1) receptor agonists, and dipeptidyl peptidase IV inhibitors should not
cause hypoglycemia.
 These drugs rely on residual endogenous insulin secretion for efficacy, and insulin
secretion should decrease appropriately as plasma glucose concentrations decline
into the normal range.
 However, all of these drugs can increase the risk of hypoglycemia when combined
with administration of insulin secretagogues or insulin.

16.  Most episodes of symptomatic hypoglycemia or of asymptomatic hypoglycemia
detected by self monitoring are effectively self treated by ingestion of glucose
tablets or carbohydrate.
 With ongoing hyperinsulinemia, the glycemic response to oral glucose is transient
, lasting for less than 2hours.
 Therefore, ingestion of a snack or meal shortly after the glucose level is raised is
usually advisable.
 In a patient who is unable or unwilling to take orally, parentral therapy is
necessary.
 Glucagon administration can be life saving, but it often causes substantial, albeit
transient, hyperglycemia, nausea and vomiting.
 Smaller doses of glucagon (150mcg), repeated if necessary is found to be effective
without side effects.

17.  • Drugs : In addition to insulin, sulfonylureas, and meglitinides, other drugs,
including alcohol, may also cause hypoglycemia.
 Excluding drugs used to treat diabetes and alcohol 164 different drugs were
associated with hypoglycemia .
 The drugs most commonly associated with hypoglycemia were quinolones,
pentamidine , quinine , beta blockers, angiotensin- converting enzyme inhibitors,
and IGF-1.

18.  Ethanol: inhibits gluconeogenesis but not glycogenolysis. Thus alcohol-induced
hypoglycemia typically follows a several day alcohol binge with limited ingestion
of food resulting in hepatic glycogen depletion.
 Sepsis: is a relatively common cause of hypoglycemia. Cytokine accelerated
glucose utilization and induced inhibition of gluconeogenesis in the setting of
glycogen depletion .
 chronic kidney disease: The mechanism of hypoglycemia is less clear. It likely
involves impaired gluconeogenesis, reduced renal clearance of insulin, and
reduced renal glucose production.

19.  severe liver failure: gluconeogenesis and glycogenolysis are impaired. cardiac
failure: The mechanism of hypoglycemia is unknown, It may involve hepatic
congestion and hypoxia.
 Malnourishment: Malnutrition can cause hypoglycemia as a result of substrate
limitation of gluconeogenesis and glycogenolysis in the setting of glycogen
depletion. Hypoglycemia has been reported in patients with anorexia nervosa
 Hormone deficiencies :Cortisol deficiency (adrenal insufficiency ) growth hormone
deficiency (hypopituitrism).

20. Nonislet cell tumors hypoglycemia(NICTH) : usually large tumors of mesenchymal
or epithelial cell types (hepatomas, adrenocortical carcinomas, carcinoids).
Hypoglycemia usually occurs as a result of tumor production of incompletely
processed insulin-like growth factor II IGF-II . but insulin secretion is suppressed
appropriately.
During hypoglycemia plasma IGF-II to IGF-I ratios are high and free IGF-II levels
and levels of pro-IGF-II are elevated.
Curative surgery is seldom possible, but reduction of tumor bulk may ameliorate
hypoglycemia.
Therapy with a glucocorticoid, growth hormone, or both has also been reported to
alleviate hypoglycemia

21.  Correction of sepsis and improvement in hepatic and renal function improves
hypoglycemia of the critical illness.
 Deficiencies of counterregulatory hormones can be corrected with replacement of
relevant hormone.
 Complex carbohydrates such as bread, rice and pasta should be consumed
frequently.
 Diazoxide is a potassium channel activator, first developed as an antihypertensive
agent, but now more commonly used in the context of hypoglycaemia due to
inhibition of insulin secretion.
 somatostatin inhibits insulin production, and analogues can be used in any state
of chronic hyperinsulinaemia.

22.  Check blood sugar often, if below 70mg/dl (milligrams per deciliter) stabilize it by
eating.
 Full conscious patient: 1- oral glucose , sucrose or any sugar containing fluid.
 Patient mental function:
 1- IV 50% dextrose 25 – 50 ml or as much as possible until patient mental state
recover.
 2- If hypoglycemia is caused by long acting insulin continue 10% dextrose drip for
24 hr. – 48 hr.
 3- Glucagon 1 mg IM , SC can be given to treat severe hypoglycemia if IV accesses
difficult.

23.  Checking blood glucose levels - keep a regular check on blood sugar levels and
identify the onset of symptoms.
 Eat regularly - keep to your eating routine.
 Exercise - make sure you have eaten some carbohydrate-rich food before you do
any exercise

24.  https://www.amjmed.com/article/S0002-9343(14)00584-1/pdf
 https://www.hormone.org/hormone/diseases-and-conditions/diabetes/non-diabetic-
hypoglycemia
 https://www.uptodate.com/contents/hypoglycemia-low-blood-sugar-in-diabetes-
mellitus-beyond-the-basics
 https://www.medicalnewstoday.com/articles/166815.php
 Google Images